Antony Jacob, CEO, Apollo Munich Health Insurance, on standardisation of health insurance norms-
Q. What changes will standardisation bring?
A. Our research shows that there are terms that people continue to seek redressal for. These include co-pay, day-care treatment and pre-existing diseases. Often, customers are not aware of how different insurers define these terms. Standardisation will help people understand the commonly-used terms better.
Q. How will companies make their products stand out in the standardised regime?
A. We believe the guidelines provide standard definitions of terms to make it easy for customers to understand what is going on. Hence, these give companies the flexibility to enhance their offerings. Some differentiating factors could be better coverage, inclusion of additional illnesses, health management services, etc. One factor that will certainly set companies apart from one another will be service quality.
Q. The guidelines say permanent exclusions have been "an area which has otherwise been fairly variable in its interpretation." Can you explain how exclusions are defined differently and how standardisation will change the scenario?
A. Until the standard guidelines were introduced , companies offered products with exclusions and permanent exclusions, and these varied a lot from one company to another. Customers have faced situations wherein claims were not processed due to exclusions. The guidelines will ensure a hassle-free experience for customers.
Q. The norms also standardise the agreement between third-party administrators (TPAs), hospitals and insurance companies. How will this help consumers?
A. Standardisation of clauses in agreements between TPAs, hospitals and insurers is directly linked to ensuring that the decision to accept or reject a claim is finally the responsibility of the insurer. The responsibility of claims management cannot be transferred to TPAs, who are only a servicing vehicle. The guidelines will ensure that TPAs do not use their discretion in any process without insurers' knowledge.