FM DECEMBER 2018 ISSUE - digital edition
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questioned based on non-disclosures<br />
or misrepresentations at the time<br />
of taking the policy. It has also<br />
proposed to review and standardize<br />
the exclusions applied by insurers for<br />
alcohol and substance abuse.<br />
Advanced treatments<br />
It suggested the formation of the<br />
Health Technology Assessment<br />
Committee for examining and<br />
recommending the inclusion of<br />
advancements in medical technology<br />
as well as new treatments and drugs<br />
introduced in the Indian market for<br />
coverage under Insurance. According<br />
to the working group, a detailed<br />
procedure based on international<br />
practices needs to be followed by the<br />
committee for inclusion and exclusion<br />
of modern or new technologies and<br />
treatments. It suggested that no<br />
exclusions should be permitted for<br />
any advancement in technology and<br />
advanced treatments if they are in the<br />
list approved by the committee.<br />
INSURERS SHOULD<br />
NOT DENY COVERAGE<br />
FOR CLAIMS OF ORAL<br />
CHEMOTHERAPY AND<br />
PERITONEAL DIALYSIS<br />
The working group further<br />
recommended that the insurers should<br />
not deny coverage for claims of oral<br />
chemotherapy, where chemotherapy<br />
is allowed, and peritoneal dialysis,<br />
where dialysis is allowed. It suggested<br />
that insurers start adopting an<br />
Explanation of Benefits (EOB) in their<br />
prospectus as well as policy schedule<br />
and wordings, which can be easily<br />
understood by customers. After<br />
reviewing the entire list of optional<br />
items, the working group suggested<br />
classification of existing optional items<br />
into items that may be retained as it<br />
is as optional items, costs that are to<br />
be subsumed into room charges, costs<br />
that are to be subsumed into specific<br />
procedure charges, costs that are to be<br />
subsumed into the cost of treatment<br />
and costs that are to be subsumed<br />
into diagnostics.<br />
The working group observed that<br />
the changes recommended in the<br />
report would have some effect on<br />
the pricing of the respective products.<br />
It proposed that policy wordings<br />
would also have to be reworked and<br />
filed with the regulator. The insurance<br />
companies also stated that the<br />
prices of policies are likely to go<br />
up if the recommendations are<br />
implemented. The working group also<br />
recommended that all deaths due<br />
to vector-borne disease should be<br />
classified as death due to disease and<br />
not as death due to accidents. But<br />
injuries or death caused by mauling<br />
by wild animals, snake bite, scorpion<br />
bite and dog bites can be termed as<br />
accidental injuries.<br />
<strong>DECEMBER</strong> <strong>2018</strong> / FUTURE MEDICINE / 59