IRDAI to set up common electronic platform to settle health insurance claims




The Insurance Regulatory and Development Authority of India (IRDAI) is looking at setting up a common electronic platform for settling health insurance claims.

The platform, which is expected to come up soon, will help standardise settlements and ensure that they are done within a specific period of time, said TL Alamelu, member (non-life), IRDAI.

IRDAI has already formed a committee on this, and the platform will be developed by the Insurance Information Bureau. “The idea of forming this platform is (to ensure) that all are there on a single platform, that is the insurer, insured, and hospitals – and the claims will be processed on this platform. This will give a rich wealth of data, apart from standardising settlement and ensuring that settlements are done within a specific period in time,” she said at a health insurance summit organised by Assocham here on Friday.

The common platform will bring a paradigm shift in the way claims are being settled in health insurance, she observed.

Acknowledging the fact that the health insurance ecosystem in India is distorted primarily due to wide disparity in charges, Alamelu said that IRDAI is looking at the possibility of standardising charges of some of the procedures such as cataract surgery and hysterectomy.

There is a wide disparity in charges for these frequently opted procedures across different hospitals, giving rise to ambiguity. IRDAI is working more “in an informal manner” with the help of General Insurance Council and with all TPAs (third-party administrators) to standardise charges for at least some of the procedures. As a regulator, IRDAI ensures that insurance companies do not jack up premiums every year or make changes to the policy because they are not able to make profits. However, it is noticed that hospitals keep making changes to the tariffs of various procedures due to the lack of a regulator.

“It is being noticed that hospital inflation is 10 per cent to 15 per cent whereas in premiums there is no inflation impact; it is being maintained at a steady rate.... so, there is a mismatch. This is one issue that we are progressively thinking as to how to handle,” she said.

Sandbox approach

IRDAI is also open to the idea of opening a second window for inviting proposals under the sandbox model. Under its regulatory sandbox approach, IRDAI has already received close to 173 proposals. According to Alamelu, a majority of the proposals received under health insurance were related to wellness, linking premiums to various wellness apps and instruments. “There may be a second window (for sandbox), may be some months or a year later. The industry should start thinking of something that is disruptive, covering a huge population yet making it simple by the use of technology,” she pointed out.

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