In a radical change, the recently-constituted Health Insurance Forum is set to recommend that fees charged by hospitals from patients with mediclaim policies might be capped.
The forum, constituted by the insurance regulator to help evolve policies and processes for the health insurance sector, is set to bring sweeping changes. For instance, it is also thinking of capping the rate of increase in premiums during renewals of claims. Besides, life insurance companies should issue policies with a minimum tenure of five years. On portability, the industry is talking about standardising the wording, along with a data-exchange mechanism to control frauds.
“These are the basic points being discussed in the initial meetings. We would like to see that these recommendations are in place by the next financial year. However, these are broad points, and it would take some time before new forming new regulations,” said a source privy to the discussion.
The fees hospitals can charge would be capped depending on the type of disease and the class of the hospital. This is aimed at reducing medical charges for the insured, as in India, a hospital tends to typically overcharge in case of cashless mediclaim polices.
“In India, for the same treatment, fees are higher for people with health insurance policies, while patients who don’t have such policies are charged lower. This practice is more pronounced for cashless policies. In developed countries, the situation is the opposite—people without health insurance policies are charged much higher,” the source said.
The members of the forum would include chief executives of health insurance companies, life insurers, third-party administrators (TPAs), officials from labour and health ministries and representatives of the health service providers.
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The forum also favours capping the increase in premiums in case of a claim. The policy document should include the extent of the increase in premiums in case of claims.
“Right now, there are no such norms. Insurers increase the premiums based on their respective claim experiences, but there is a need for some standard norms for such rises. Policyholders should have some idea of the possible increase in premiums during renewals,” said another source.
Other changes being considered are removing the entry age barrier in health insurance policies, which would benefit senior citizens, sources said. Typically, for most existing health insurance plans, the entry age is capped at 65 years.
From October 1, the Insurance Regulatory and Development Authority had approved portability of health insurance schemes, allowing customers to change insurers without losing policy benefits. However, the scheme is yet to pick up, as there is concern regarding data exchanges between insurers. Keeping this in mind, the forum favours a standardised policy wording.