Amid Covid, insurers to make health claims data public

Hyderabad: Zeroing in on a health insurance plan can be tough. While policy buyers usually take into consideration the pricing and health conditions covered before opting for a health cover, now they will also be able to compare the claims settlement data of insurance companies before choosing a plan.

To bring in more transparency in the operations of the health insurance industry and help customers make an informed choice, insurance regulator, Insurance Regulatory and Development Authority of India (IRDAI), on Wednesday issued guidelines stating that all general and health insurance companies will have to make claims settlement data public.

The information will have to be published within a period of 90 days after the close of every financial year. Insurers will have to disclose information pertaining to the number of policies and lives serviced along with geographical area in which services are rendered by the company or its third party administrators (TPAs).

Each insurer will also have to publish data regarding the number of claims processed, including outstanding number of claims at the beginning of the year, number of claims received during the year, claims paid during the year, claims repudiated and outstanding at the end of the year. Insurers have been directed to make public the turnaround time (TAT) for cashless claims (for both individual and group policies) and TAT in case of payment/repudiation of claims.

Besides, they will also have to make public the data about the grievances received against TPAs. The insurance sector watchdog has directed all TPAs to share the requisite data with the insurers to enable them to publish information on their respective websites. It has said that in the case of termination of services of a TPA, the insurer shall publish the same on its website citing reasons for termination within three days from the effective date of termination.

Amit Chhabra, head, health insurance, policybazaar.com, said, “Since the Covid-19 crisis, IRDAI has been issuing guidelines to make insurance products more focused towards customer needs. It has issued guidelines on public disclosures by insurers on the qualitative and quantitative parameters of health insurance policies offered. This will provide more clarity to both insurers and customers on the services provided and help customers make a more informed decision.”

Source: The Times of India