V Jagannathan, Chairman-Managing Director, Star Health and Allied Insurance, on standardisation of health insurance norms -
Q. The guidelines are giving standard definitions and 'not standardising' services. How do you think companies will make their products stand out in a cluttered market?
A. The attempt is to convey the meaning or intent of certain commonly-used terms in health insurance. Standard definitions do not take away the liberty of individual companies to innovate but only ensure that these words mean the same in all health insurance policies.
Q. A common pre-authorisation and claim form has been suggested. How is it going to streamline the claims process? How will the optical character recognition (OCR) format work?
A. The purpose of having common pre-authorisation and claim forms is to avoid unnecessary queries in claim processing. The OCR format makes the writing legible and error-free. It has been found to eliminate errors in data transmission as subjectivity is removed.
Q. Pre-existing disease have been defined 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 prior to the first policy issued by the insurer." Does this mean diseases where you have not received any treatment in the last 48 months won't be treated as pre-existing?
A. No, treatment alone cannot be taken in isolation. It should be read along with other terms and conditions. With the introduction of portability, the position is that the 48-month period will count from the day the policy has been with any insurer.
Q. A standard list of 199 excluded expenses in hospitalisation indemnity policies has been given. Can insurance companies add to this list or they have to stick to these 199 inclusions?
A. Insurance companies cannot increase the list but depending upon their convenience they can reduce or eliminate some expenses from the list of exclusions.