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ANNUAL REPORT 2007-08

look into the areas of registration of stand alone health insurance companies and to suggest innovations in health insurance products. The recommendations of these sub- committees have triggered progress in both these areas. The industry has already witnessed the entry of two stand-alone health insurance companies, M/s Star Health and Allied Insurance Co Ltd and M/sApollo DKV Insurance Co Ltd. Newer and innovative products are being designed and made available, to meet the varied requirements of the consumers. Hospital Daily Cash Benefit and Hospitalization/ Critical Illness benefit products have added variety to the indemnity products which have predominated the market so far. There are some earmarked products for Senior Citizens, for specific diseases like Diabetes and Cancer. For lower socio-economic groups, products providing outpatient coverage, and those covering pre-existing diseases are available none of which were not available until recently. This pace of innovations is increasing steadily.

Other Committees in recent years which studied various aspects of Health Insurance include the Committee on Rural Health Insurance, and the Committee on Parliamentary Undertakings of the Parliament. InApril 2007, IRDA appointed a Committee on Health Insurance for Senior Citizens to study and make recommendations regarding the concerns that Senior Citizens face in obtaining health insurance. The committee submitted its report in November 2007 and has made several recommendations, actions on some have to be taken by the Government and some are by the IRDA. Many of these recommendations were accepted by the Authority and have already been taken up for implementation.

IRDA also worked in close tandem with industry chambers on areas related to health insurance. The 1st CII Health Insurance Summit was held in Mumbai on 5th October 2007. IRDA supported the formation of 4 working groups by the Confederation of Indian Industry, which deliberated on specific areas of health insurance, viz. Data Standards, Provider Standards, Payor Standards and Awareness of Health Insurance. These groups submitted their recommendations in April 2008. The FICCI workshop on Sustainability of Health Insurance was held in Delhi on 29th November 2007. IRDA has also participated in a sub-committee of the Federation of Indian

Chambers of Commerce and Industry which is deliberating over issues pertaining to sustainability of health insurance.

The general insurance has taken industry initiatives in standardizing a uniform definition of ‘Pre-Existing Diseases’ and its exclusion wording and has come into effect from June 1, 2008. It is expected that such standardization of terminology will help the insured by increasing clarity and minimizing ambiguity in policy wordings and help comparability of health insurance products across insurers.

During 2007-08, IRDA has also established a separate Health section in the Authority with specialists and is also planning to augment the existing resources.

Third Party Administrators

Third Party Administrators (Health Services) have grown both in number and in volume of business. During 2007-08, two more companies have been granted licence to act as TPAs. One company Dawn Services Pvt. Ltd did not apply for the renewal of licence. Further, TPAs enlarged their network of operations and are engaging people who are trained in ICD-10 coding so as to facilitate analysis of health insurance data. Besides a number of hospitals in different parts of the country are being added to the TPA network for cashless settlement of claims. This welcome indicator reveals that health insurance policy holders can get cashless treatment in many hospitals across the country. The table in the next page highlights of infrastructure facilities of the TPAs.

During year 2007-08, the TPAs have received 1986859 claims,

    • 7.96

      per cent more than 1840298 claims received during 2006-

  • 07.

    The TPAs have settled 76.17 per cent of the claims received

within a period of one month. There is an improvement on outstanding claims as the outstanding claims as percentage of total claims has come down from 8.53 per cent in 2006-07 to 7.89 per cent in 2007-08.

The table in the next page lives the time taken by the TPAs in settling the claims.

vi) Business in the rural and social sector

The Authority framed Regulations on the obligations of the insurers towards rural and social sectors. Such obligations

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