In February last year, the Insurance Regulatory and Development Authority (Irda) said it was issuing a standard definition for 46 commonly used terms in health insurance, in respect of all policies issued by life and general insurers.
"Although health insurance is rapidly growing, access to it still remains limited and complaints, especially due to variable interpretations of key policy terms, are enormous," it explained. "All insurers shall adhere to the stipulated definitions, while defining these 46 core terms in all policies," it said.
However, policyholders' plights are far from over.
Take the case of Anand Kumar, whose wife had high fever for four days continuously. When it refused to subside, Kumar was advised a blood test and his wife showed symptoms of both malaria and typhoid.
The doctor advised admitting her to hospital, to control the fever at the earliest. The rest of the treatment could continue after she was discharged. Kumar agreed instantly.
Yet, when Kumar presented a claim against his health insurance policy, his insurer rejected it, saying its view was that hospitalisation wasn't required. The health insurance contract excluded 'medical expenses where inpatient care is not warranted'.
Text: Neha Pandey Deoras, Business Standard
Image courtesy: Reuters