Insurance regulator, Insurance Regulatory Development Authority of India (IRDAI), is in favour of standardisation of health services through rating of hospitals for insurance claims.
According to a senior official at IRDAI, the regulator is consulting National Accreditation Board for Testing and Calibration Laboratories (NABL) for rating the hospitals.
Under the rating mechanism, insurers can charge on the basis of grades based on facilities like number of doctors or equipment in the hospital. For example, charges applicable in a three-star hospital would be different from a five-star hospital.
IRDAI already has a registry of hospitals and medical day-care centres, in the health insurers and Third Party Administrators (TPAs) network, created to benefit health insurance stakeholders. Named as Registry of Hospitals in Network of Insurers (ROHINI), the database lists approximately 33,000 unique hospitals and medical day-care centres. Each hospital/day-care centre is identified with a 13-digit globally unique GS1 identifier (GLN – Global Location Number) along with geo-coding of their address.
Rating of hospitals would be an addition of this database, as will lead to more standardisation the health insurance segment.
IRDAI has been moving towards standardisation of health insurance products to make them more accessible to common people. In September this year it came out with guidelines on standardisation of exclusions in health insurance contracts. The guidelines brought in standardization of various definitions and formats in the health insurance industry to promote uniformity. One of the major changes involved include inclusion of age-related ailments like knee-cap replacements, cataract surgery, alzheimer’s and parkinson’s, under health insurance, which were earlier excluded from the health insurance policy. It also brought more transparency in defining pre-existing diseases.
Under standardisation, the insurance regulator has proposed to "mandate all general and health insurers to offer a standard indemnity-based health insurance product with a sum insured ranging from Rs 1,00,000 to Rs 5,00,000 on individual as well as family floater basis”.
In February this year, IRDAI had come out with draft guidelines on standardisation of individual health product.
During FY20, general and health insurance companies collected Rs 44873 crore as health insurance premium, registering a growth of about 21 per cent over the previous year. The sector has been growing annually at the rate of over 20 per cent, one of the fastest growing segments in the insurance industry. Last year, more than 20 million health policies were issued covering close to 472 million people.