The Insurance Regulatory and Development Authority of India (IRDAI) is planning to bring out a common forum for claim settlement in health insurance soon.
The platform will bring all the stakeholders in the health space—insurers, insured, as well as hospitals—under one roof, with an aim to standardise the claim settlement procedure amd make it time-bound. The regulator has already formed a committee to look into the proposal, said T L Alamelu, member (non-life), IRDAI, at an insurance summit organised by Assocham (The Associated Chambers of Commerce and Industry of India) in Kolkata today. This platform will be developed by Insurance Informatics Bureau.
“The idea of forming this is to bring all stakeholders -- the insurer, the insured and the hospital -- on to a single platform. All claims will be settled in this platform. This will give a wealth of data, apart from standardising settlements and ensuring they are done within a specific period of time,” she said, adding, “We hope that this will bring a paradigm shift in the way claims are being settled in health insurance.”
The regulator is also in the process of eliminating the disparity in the charges of hospitals for certain common procedures. At present there is a huge difference in the charges of similar procedures by different hospitals.
IRDAI has also expressed concerned over the rising inflation in hospital bills.
"So there is a mismatch (in pricing). IRDAI is thinking of ways to handle it. In this context, the General Insurance Council's talks with the TPAs are on course to standardise charges for some procedures like cataract and hysterectomy," Alamelu said. “It has been noticed that hospital inflation at present is ten per cent to 15 per cent and tariffs are being changed on a regular basis…There is no body to check that."
"We also plan to introduce systems where the public will have the liberty to chose their TPAs," she said.
Second sandbox to cover huge population
IRDAI is planning to come out with a second window for proposals under sandbox mechanism. Recently, the regulator
The first window for submitting applications was open for around 30 days in September and October 2019. The regulator received 173 proposals, most of which pertained to wellness and use of technology in health insurance. Many involved using fitness apps for determining premiums.
“We are also looking for a more disruptive sort of policy. There will be a second window, may be some months later or year later. It should cover a huge population and also be simple,” she said.
Regulatory Sandbox usually refers to live testing of new products in a controlled environment, wherein regulators may permit some relaxation for the limited purpose of testing. It is similar to a pilot project and the insurer is free to withdraw the product in case it doesn't succeed, as long as it doesn’t impact customers who have already bought it.