The Insurance regulatory and Development Authority (IRDA) drafted some health insurance guidelines on 31st May 2012. These will restrain the role of the TPA to process claims. There are still some issues which have to be addressed. The IRDA agreed to address various important issues like, settlement of claims within 30 days of receiving documents, lifelong renewals, refund on pre-insurance medical check-ups and a separate grievance cell for senior citizens.
On the 16th of May 2012, a memorandum had been submitted by Moneylife foundation, to J. Hari Narayan, chairman of IRDA.
According to the memorandum:
Senior Citizens could not increase their Sum Insured, also survivors of serious illnesses like cancer were not allowed to increase the sum assured. The insurance company manages to do this under the guise of “Right to Underwrite” It should be mandatory to allow increases due to inflations, irrespective of past claims.
Prosthetics and Artificial limbs for the disabled were not covered. ‘The Challenging Ones’ – an NGO in a memo to the IRDA Chairman on the 16th of May requested him to make it mandatory for insurance companies to cover the cost of prosthetics to the beneficiaries without an artificial cap. Many insurance companies don’t have regulations for this.
Even after the chairman’s assurance there has no response from the IRDA and neither have reminders elicited any response.
Most Insurance companies reject insurance for procedures which do not require a 24 hour stay at the hospital. IRDA needs to include day care procedures as the technology has advanced and don’t necessitate an overnight hospital stay.
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The cashless facility is limited to preferred-provider network; this does not involve the majority. When cashless is offered to corporate, it should be made available to retail mediclaim beneficiaries.
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References:
Hannah Punitha (IRDA Licence Number: 2710062)
Raj Pradhan, Feb 2013
Source-Medindia