Definition of 46 health insurance terms standardised

Insurance Regulatory and Development Authority has issued guidelines that standardise terms in health insurance policies. This is to bring about clarity and enable insurance companies to provide better service to policyholders.

The comprehensive guidelines have standardised definitions of 46 terms that are commonly used in health insurance policies and 11 critical illness terms to bring uniformity in sales, claims and settlement processes of insurers.

These critical illnesses include cancer, first heart attack, open-heart valve surgery, coma, kidney failure, stroke, major organ transplant, paralysis of limbs and multiple sclerosis.

“Standard terms would reduce ambiguity, enable all stakeholders to provide better services and enable customers to interact more effectively with insurers and third party administrators. All insurers shall adhere to the stipulated definitions, while defining these 46 core terms in all health insurance policies,” said IRDA in a circular.

The insurance regulator also put out a standard list of 199 excluded items in hospitalisation indemnity policies. “However, insurers may include these exclusions, if the product design allows for, or if the insurer wants to include these as part of hospitalisation expenses,” said the circular.

The guidelines will be effective from July 1, 2013, for group products and October 1, 2013, for other products.

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