Joydeep Roy, CEO, L&T General Insurance, on standardisation of health insurance norms -
Q. The guidelines standardise agreements between TPAs, hospitals and insurers. How will this change the playing field?
A. According to the current practice, there are two separate agreements, one between the TPA and the insurer and another between the TPA and the hospital. The norms seek one agreement between the three. This means these parties will be aware of the terms and conditions, removing ambiguity.
Q. Will a standard agreement be beneficial for all stakeholders?
A. Although standardisation is going to make the process smoother, there will be an initial period of discomfort where all the parties will go through a stage of adapting to the new system. According to one of the proposed regulations, an insurer dealing with multiple TPAs will need to have multiple tripartite agreements. This will have to be managed through a proper system which will require an increased level of management involvement. For instance, if an insurer has five TPAs and each TPA has 4,000 hospitals in its network, the insurer will have to maintain 20,000 agreements if entering into tripartite agreements with everybody is impractical. Additionally, since hospitals do not fall under Irda, it may be a challenge to get their consent to enter into so many different agreements. However, in the long run, it will prove to be beneficial for all stakeholders.
Q. A common pre-authorisation and claim form has been suggested. How is it going to streamline the claims process?
A. At present, all insurers have their own claim forms. Even the order is mostly different. A common form will streamline the process. The customer will just have to understand one format for all the different policies he may have. Hospitals will also benefit as they deal with a number of customers and insurers at any point of time.