What is the Standardization of a Health Insurance Policy in India?

Health insurance's importance can never be ignored by anyone. In the past, numerous health insurance claims had rejected, and this high denial rate steered the Indian Government to take a new step i.e., Standardization of health insurance policy. During this standardization process, new rules were formulated, making insurance claims much more comfortable. These new rules reduced the chances of claims' rejection, letting people get money as well as treatment on time.


IRDAI (Insurance regulatory and development authority of India)

The Standardization of this insurance policy assigned to IRDAI i.e., the Insurance Regulatory Authority of India, and the job done very well. It did not just help policyholders to get medical assistance in time but also introduced specific improvements in the Indian healthcare industry.

In this Standardization process, IRDAI clarified all of the terms and conditions for the valued policyholders. Some of them are as follows.


It stated that any disease should be treated within 45 days of consultation with concerned doctor od hospital where the same was originated or initially tested

Cashless Services

The policyholder will be able to get healthcare abilities without paying any cash and insurer will make sure of the same


The insurer will make an agreement with the policyholder to pay for health services in agreed proportion i.e., percentage or they will divide the same with respect top the disease or medical urgency

Dental Treatments

Dental treatments are usually never added in insurance policies, but for the first time, these treatments were introduced by IRDAI including filling, cleaning, scaling, and root canals

Grace Period

The policyholder will be given the grace period where delayed insurance premiums will have no effect on benefits and perks. But  the same should not exceed the specified dates as agreed by both the parties

Emergency Treatments

Emergency treatments will be given to policyholders in all cases even if the same is not covered

Hospital Needs

IRDDAI redefined the term Hospital for the very first time where health facilities were improved significantly.  For any facility, the following has to be met:

  1. Minimum ten beds must exist
  2. Nursing staff must be on-duty 24/7
  3. All practitioners, medical staff, doctors, and professionals must be highly qualified and verified professionals
  4. There must be a minimum one OT (Operation Theatre) in the facility or hospital surroundings containing mandatory instruments and medical facilities
  5. There must be a chronological record for each patient and all insurance agencies, and Government institutes must have the same access 

There were many other terms defined by IRDAI, but we have listed very few of them.

Concluding Remarks

Summing it all up, what we have presented above is India just, but this must be the same for all countries globally. Health insurance and its application have become a prime need now, and one can't really afford expensive medical treatments, especially if someone resides in Europe or the Middle East. There has to exist a specific agreement between insured individual and insurance provider, and each and everything must be clearly presented so that later hassles can be avoided easily. 

Last but not least, health insurance also covers maternity and emergency cases, which is also something valuable for individuals and families, and IRDAI has also insisted on the same for its policyholders too.


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Norainizah - Mar 26, 2020, 12:17 AM - Add Reply


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