3 Pillars Of Support On Claims

In the last 6-8 months, Irdai has introduced a set of regulatory changes that promise to resolve issues that previously often led to poor outcomes on health insurance claims

- ABHISHEK BONDIA

Recently, a senior executive of a health insurance company was lamenting about the fast pace of regulatory changes that they need to catch up with. While he complained about the increased work, he could not help but compliment the Insurance Regulatory and Development Authority of India (Irdai) for keeping the policyholder’s interest at the heart of these changes. Ultimately in the long-term, the satisfaction of policyholders will drive the industry development, he said.

I totally agree. Health insurance is a complex service-oriented product with multiple layers. At the time of signing up, policyholders buy into a promise of future time-bound help. They count on the policy for support, when they are adversely affected financially as well as health-wise.

Both finance and health are sensitive areas. Nobody appreciates a surprise at the time of making a claim. At times, an adverse or delayed claim decision can impact the future line of treatment. With a solid appreciation of these factors, the regulator has taken cognisance of areas that typically cause service-level dissonance.

The country already has a solid set of product regulations, such as life-time renewability, portability, and standardisation of exclusions. On top of that, a set of regulatory changes have been introduced in the last 6-8 months. These guidelines are specific, and targeted towards grassroot issues that lead to poor outcomes for the policyholder.

Each of the recent changes carry a powerful impact on a standalone basis. I see three large themes behind these new regulations—empowerment, standardisation, and pre-mitigation.

Empowerment