Topic 2: Health Insurance turns focus on product structures
Two very important events marked 2018 for health insurance. One was the launch of Pradhan Mantri Jan Arogya Yojana (PMJAY) that offers health insurance to the underprivileged and the constitution of a committee on health insurance that looks at standardizing and rationalizing clauses in a health insurance policy. “PMJAY comes with no exclusions and therefore is a policy that springs no surprise to the insured. This is not the case with retail health insurance. However, the launch of PMJAY, court orders in certain cases and a report of the Irdai working group on health insurance exclusions have initiated a healthy debate,” said Kapil Mehta, co-founder, SecureNow.in.
In July this year, Irdai set up a committee to look at standardizing exclusions in health insurance. The committee submitted its report which not only proposed a much sharper and unambiguous definition of pre-existing ailments, one of the main clauses that lead to claims rejection but also recommended that insurers can’t deny a claim on the ground of non-disclosure after an eight-year window.
Also, acting on the Mental Healthcare Act, 2017 that prohibits any discrimination between mental illness and physical illness, Irdai directed insurers to make provisions for medical insurance for treatment of mental illness on the same basis as is available for treatment of physical illness. This simply means that health insurance can’t discriminate or exclude mental illness and will have to cover any related hospitalization. This doesn’t mean that insurers are mandated to insure people who are diagnosed with mental illness as that would depend on their underwriting criteria, but if an insured person is diagnosed with mental illness and is hospitalized, the insurers can’t deny cover.
“I would call the year 2018 as the year of consolidation as the focus was on tying up the loose ends. For instance, this year in the health insurance space the focus has been to simplify and standardize exclusions which will go a long way in customer understanding and will aid customer protection. This year also saw new insurers focused only on digital and has given a push to e-commerce. The regulator also took steps to create a conducive environment for technology,” said Tapan Singhel, managing director and chief executive officer, Bajaj Allianz General Insurance Co.Ltd.
Source:Live Mint
In July this year, Irdai set up a committee to look at standardizing exclusions in health insurance. The committee submitted its report which not only proposed a much sharper and unambiguous definition of pre-existing ailments, one of the main clauses that lead to claims rejection but also recommended that insurers can’t deny a claim on the ground of non-disclosure after an eight-year window.
Also, acting on the Mental Healthcare Act, 2017 that prohibits any discrimination between mental illness and physical illness, Irdai directed insurers to make provisions for medical insurance for treatment of mental illness on the same basis as is available for treatment of physical illness. This simply means that health insurance can’t discriminate or exclude mental illness and will have to cover any related hospitalization. This doesn’t mean that insurers are mandated to insure people who are diagnosed with mental illness as that would depend on their underwriting criteria, but if an insured person is diagnosed with mental illness and is hospitalized, the insurers can’t deny cover.
“I would call the year 2018 as the year of consolidation as the focus was on tying up the loose ends. For instance, this year in the health insurance space the focus has been to simplify and standardize exclusions which will go a long way in customer understanding and will aid customer protection. This year also saw new insurers focused only on digital and has given a push to e-commerce. The regulator also took steps to create a conducive environment for technology,” said Tapan Singhel, managing director and chief executive officer, Bajaj Allianz General Insurance Co.Ltd.
Source:Live Mint