The health insurance sector has witnessed steep growth during the past few years in India. This has largely been contributed by the fact that people now understand the importance of health care and health insurance as a medical treatment has gone expensive over the years. Another factor leading to the growth of this factor is an increase in disposable income of the people.
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The main aim of the health insurance industry is not to sell and market health insurance policies but also provide timely and efficient claims during their requirement. Health insurance policyholders often complain about claims being denied by the insurance company on perky grounds. This has resulted in regulatory authority to develop new standardized procedures to help people to make successful claims.
The insurance sector is regulated by the Insurance Regulatory Development Authority (IRDA) of India in our country and the organization has introduced several new rules to standardize this sector aiming to increase the convenience of insurance holders.
In order to avoid misunderstandings and ambiguity of the insurance policies, the regulatory body has defined guidelines to standardize health insurance practices in the country. It has laid some rules which are required to be used as a mandatory clause in the documentation of each and every health insurance policy.
Some of the guidelines framed by IRDA insurance include critical illness, pre-existing diseases, hospitalization etc. The regulatory body has defined these terms and health insurance companies are required to be used the same words while framing policy wordings for each and every policy. the body has defined pre-existing disease as “Any condition, ailment or injury or related condition(s) for which you had signs or symptoms, and / or were diagnosed, and / or received medical advice / treatment within 48 months to prior to the first policy issued by the insurer” and hospitalization as “A minimum stay for 24 hours in the hospital”. Further, the hospital has been defined as more clearly as “A hospital should have at least 10 inpatient beds, in those towns having a population of less than 10, 00,000 and 15 inpatient beds in all other places”.
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These new guidelines laid down by the IRDA insurance regulatory body aims to decrease the frauds and to increase satisfaction among insurance policyholders. The other main reason for laying these rules is to increase the trust between insured and insurer in order to facilitate the development of this sector. With these simplified rules, insurance seekers will be able to understand different clauses of the policy and will help them to buy suitable policy meeting their needs.