Considering the importance of standardization in healthinsurance and to enhance transparency and uniformity the Authority had fromtime to time issued guidelines on standardization such as; standardization ofterminology to be used in Health Insurance Policies and Standard Nomenclatureand Procedure for Critical Illnesses. With the increase in the number of companiesproviding Health Insurance there is an increase in the number of productsoffered. It is desired that the industry adopts a uniform approach whileincorporating the ‘exclusions’ as part of product design as well as for the wordingof the ‘exclusions’.

In order to examine the above issue and submit suitablerecommendations a working group is constituted with the following Members.

1.   MrSuresh Mathur, E D (Health), IRDAI

2.    MrHarish Nadkarni, CEO, NABH

3.    MrAnnaswamy Vaidheesh, Chairman, CII Sub-committee Health Insurance

4.    Mr RMSingh, G M, New India Assurance Co

5.    Mr DSai Srinivas, Appointed Actuary, Bajaj Allianz Life Insurance Co

6.    MrShreeraj Deshpande, SVP & Head - Operations, Future Generali GeneralInsurance Co

7.    DrVikram Jit Singh Chhatwal, Whole-Time Director, Medi Assist TPA

8.    Dr SPrakash, COO Star Health

9.    Mr DV S Ramesh, G M (Health), IRDAI

10.DrPankaj Sharma – Convener

MrSuresh Mathur, E D (Health) shall be Chairman of the working group.

Termsof reference for the working group shall be: -

     i.       Examinethe exclusions that are prevalent in the health insurance policies.

   ii.       Rationalizethe exclusions by minimizing the number, so as to enhance the scope of healthinsurance coverage granted.

  iii.       Rationalisethe exclusions that disallow coverage with respect to new modalities oftreatments and technologically advanced medical treatments.

  iv.       Identifythe type of exclusions which shall not be allowed.

   v.       Studywordings/language of the exclusions and standardize the wordings of exclusionsin a simple and easily understandable language.

  vi.       Studythe scope for allowing individual specific and/or ailment/disease specific permanentexclusions at the time of underwriting so that the policyholders are not deniedhealth insurance claims unrelated to the exclusions.

  vii.       Anyother matter relevant to the subject of exclusions.

It is advised that the working group may hold meetings asand when needed and submit a report with recommendations within eight weeks fromthe date of this order. The working group may invite other persons to themeeting(s) as special invitees as may be required.

Member (Non-Life)