'ËĘ ÁflÁŸĸĘ∑§ •ı⁄U Áfl∑§Ę‚ Ž˝ĘÁœ∑§⁄UáĘ - IRDA

end-user sectionExample 2Positive languageirda journal October 2012Before:Claim in respect of Cashless AccessServices will be through the TPA providedadmission is in a listed hospital in theagreed list of the networked hospitals andis subject to pre admission authorization.The TPA shall, upon getting the relatedmedical details / relevant informationfrom the insured person / networkhospital verify that the person is eligible toclaim under the policy and after satisfyingitself will issue a pre-authorisation letter /guarantee of payment letter to thehospital mentioning the sum guaranteedas payable, also the illness for which theperson is seeking to be admitted as inpatient.After:The cashless facility is available only fortreatment in network hospitals throughthe TPA. The procedure for availing thisfacility is as follows:1. You must seek authorisation from theTPA before getting admitted into thehospital.2. You must give to the TPA all medicaldetails and the information that theTPA will ask you to give. The TPA willalso seek information from thehospital, and will verify whether youare eligible for a claim under thispolicy.3. The TPA will give to the hospital aletter of authorisation or guarantee ofpayment that will state the amountand the illness for which the TPA willpay under the policy.Active voiceActive voice can replace passive voice. Theactive voice clearly identifies the persondoing an action. An insured willunderstand active voice quickly and easily.When passive voice is used, he is requiredto process information. He wonders andmust find out who is responsible for theaction mentioned in the sentence.Example 1Before: Passive VoiceIf no claim has been made under theSection 1 of this Policy and the Policy isrenewed with us without any break, wewill apply a cumulative bonus ….After: Active VoiceWhen you renew the policy with us, wewill give you a cumulative bonus … if:i. you have not made a claim in thepolicy year, andii.you have renewed the policy beforethis policy ends.Example 2Before: Passive VoicePreliminary notice of claim withparticulars relating to …. should be givento the insurance company/TPA within 7days from the date of hospitalization inrespect of reimbursement claims.After: Active VoiceAn insured willunderstand activevoice quickly andeasily. When passivevoice is used, he isrequired to processinformation.You must give a preliminary notice to us orthe TPA within 7 days fromhospitalisation, if a claim is probable. Youmust state in this notice the following …. .Positive statements are agreeable andcomfortable to read. The reader canunderstand it easily. Negative languagecan put off the reader.Example 1Before: Negative statementFrom the time of inception of the cover,the policy will not cover the followingdiseases/ailments/conditions for theduration shown below.After: Positive statementWe pay expenses for the treatment of anyillness stated in the table below only if thatillness occurs after the period stated.Example 2Before: Negative statementCritical Illness Benefit:We will not make any payment if:(I) The insured person is first diagnosedas suffering from a critical illnesswithin 90 days of the commencementof the policy period and the insuredperson has not previously beeninsured continuously and withoutinterruption under this policy.(ii) The insured person is above the age65 of years. From the time ofinception of the cover, the policywill not cover the followingdiseases/ailments/conditions for theduration shown below.After: Positive statementWe will pay the Critical Illness sum insured…, only if:1. You are less than 65 years old.2. You are first diagnosed as sufferingfrom a Critical Illness after 90 days ofthe commencement of the policyperiod and you have been insuredcontinuously and withoutinterruption under this policy …Wepay expenses for the treatment of anyillness stated in the table below only ifthat illness occurs after the periodstated.32