The Insurance Regulatory and Development Authority of India (IRDAI) has directed insurance companies to initiate a host of measures to standardise health insurance premium rates, which the government feels can be done by following the Pradhan Mantri Jan Arogya Yojana (PMJAY) scheme model.
In a circular issued on January 30, the insurance sector regulator said that as part of the ongoing monitoring of insurance products offered in the Indian insurance market, it has been observed that there has been a steep increase in premium rates under some of the health insurance products offered to senior citizens.
No PMJAY like standardisation in case of health insurance products available, says IRDAI
“Unlike in case of Pradhan Mantri Jan Arogya Yojana (PMJAY) scheme, where the hospitalisation expenses are negotiated centrally for package rates and are thus standardised across various hospitals, there is no such standardisation in case of health insurance products. This is leading to higher hospitalisation costs resulting in higher claims outgo under health insurance products offered by insurers,” the circular said.
Hanut Mehta- CEO and Co-Founder of Bimapay Finsure, said, that IRDAI encouraging insurers to adopt standardized hospital empanelment and negotiate package rates is an important aspect. “By following a model similar to the PMJAY, the industry can mitigate inconsistencies in hospitalisation costs, leading to better financial management for insurers and making healthcare services more affordable and accessible to policyholders. Additionally, this strategy fosters closer collaboration between insurers and healthcare providers to ensure fair and efficient service delivery.”
Also read: GST Council defers decision on tax rates for health, life insurance premiums – What we know so far
Mehta noted that the IRDAI directive also emphasizes the need for insurers to actively promote the initiatives being implemented for senior citizens, adding that transparent communication regarding policy benefits and changes will empower customers with the knowledge needed to make well-informed decisions, ultimately strengthening consumer confidence in the health insurance sector.
IRDAI suggests insurers have a separate channel to address grievances
The regulator, for the benefit of senior citizens, has directed all insurers to establish a separate channel to address their health insurance-related claims and grievances. “The details of such a channel are required to be published on the respective insurer’s website.”
The requirement for insurers to establish a dedicated grievance redressal mechanism for senior citizens will significantly improve service quality and customer satisfaction,
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