Can't implement pre-packaged rates in policies: GIC to Bombay High Court

MUMBAI: General Insurance Council, which represents 25 non-life insurance companies, today told the Bombay High Court that it was not possible for its members to come out with a pre-packaged compensation in the policies on the basis of sum insured and on the type of hospital.

"We cannot introduce pre-packaged rates for various ailments in insurance policies because hospital categorisation or gradation cannot be done easily", said GIC in an affidavit.

The court was hearing a PIL filed by activist Gaurang Damani, detailing hardships faced by mediclaim policy holders.

Categorization of hospitals can be done by the union government and the states on the basis of prescribed criteria by coming out with a legislation, GIC further said.

The court had earlier asked Insurance Regulator and Development Authority ( IRDA) to come out with pre-packaged compensation for ailments covered under the medical insurance policies on the basis of sum insured and type of hospitals.

Asserting that there were practical difficulties in implementing pre-packaged rates for ailments in policies, GIC said they needed time to re-think on the issue.

Accordingly, a bench headed by Justice Mohit Shah gave three weeks to GIC to reconsider incorporating pre-packaged rates in the policies.

The GIC said there was a need to regulate healthcare and standardise the services, including quality of treatment, and improving infrastructure.

"It is primarily the responsibility of the Union of India in regulating the hospitals and categorising them on the basis of various criteria by bringing out a comprehensive legislation," the GIC affidavit said.

The General Insurance industry alone is not responsible and cannot give effective implementation of the High Court guidelines (on pre-packaged rates for ailments in policies), the GIC said.
Monitoring of hospitals for implementation of the High Court directions was not in the hands of insurance industry but was the prerogative of IRDA, it said.