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Expert committee on Health Insurance recommended changes in disclaimer wordings

May 25, 2015 16:15 IST

Expert committee on Health Insurance of Insurance Regulatory and Development Authority (IRDA) chaired by M Ramaprasad in its report has suggested changing the wordings of disclaimer in advertisements of insurance companies.

The report of the Committee was made available on the IRDA’s website on 22 May 2015.

Till date, as per the IRDA mandate all insurance companies issued a disclaimer, “Insurance is a subject matter of solicitation”, in all their advertisements. The Committee recommended the following wordings for the disclaimer “Before buying, know the conditions and exclusions, to make a well-informed decision.”

Other recommendations of the committee
• It recommended bringing in a great transparency and clarity to enable policy holders to understand the boundaries of coverage in their policies.
• It recommends that insurers and third party administrators (TPAs) should have systems in place to identify, monitor, control and deal with fraud, including hospital abuse, by various agencies including health care providers.
• It suggested an industry-level collaborative effort to minimise subjective and varied interpretation of policy terms and conditions, which is the root cause of disputes between insurers and policy holders.

Besides, it made recommendations on other issues like
• Policy holder Protection, Policyholder Servicing, Fraud Control and Risk Management
• Product, Distribution, Rural, Social Sector and Micro-insurance
• Reinsurance, Reserving and Solvency
• Capital, Accounts, Expenses of Management, Investment, and Mergers and Acquisitions
• Health Insurance Regulations 2013
• Policy holder Protection Regulations

These recommendations will help to reduce the asymmetry of information that exists among all the parties concerned that is customer, provider, payer and others.

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