Working Together to create better value for all

1. Working Together to create better value for all

2. CII Multi stakeholder focus Since 2007 October, 4 working groups were created which had Insurers - Life, General and Stand Alone, Re insurers, Regulator, Providers, TPA’s, Actuaries and Healthcare companies all coming together. The working groups worked on : 1. Data Standards, which had as its objective, suggesting mechanisms for streamlined and sustainable development of health Insurance data repository and mechanisms for information exchange among stakeholders. 2. The Payor Group had the objective of setting up minimum standards across insurers to ensure standardization of key processes and terminology which would drive the policy wording, underwriting and claim processes for health insurance 3. The Provider Group was to suggest mechanisms to achieve standards, transparency in treatment and billing standards 4. The Communication and Awareness Group was to build a concerted effort towards customer education and awareness on Health Insurance and its development

3. 2011 Outputs • This year in September we had the CII health insurance Summit – Vision 2020 • The groups submitted reports on 1. Senior Citizen Health Coverage 2. Details on data standards on Electronic Data Interchange 3. Report on Way forward on Universal health coverage After the summit a provider and insurer group was facilitated

4. Objectives • To increase transparency between the insurance companies and providers • To reduce inconsistencies in the services and processes • To achieve amicable solutions on the existing problems • A series of meetings were facilitated by CII with participation from prominent Providers, Insurance Companies - PSU and Private and TPA’s

5. Recommendations and way forward Recommendations • Adoption of Common Pre Authorisation Form • Adoption of list of Common Non Payable items • Create facilitating mechanisms Frequent training sessions for Doctors and hospital administrators on claims administrations Create a Insurance help desk in all the major hospitals • Focus on customer education and awareness • Appropriate remedial action to stop /control abuse of Health insurance and frauds - Medical fraternity to come forward and define the way forward Way forward • The CII multi stake holder s to be focused and continue working for next year focus on implementation of suggestion made

6. CII Thank You

7. Participation PROVIDERS • Medanta – The Medicity • Fortis Healthcare (India) Ltd. • Indraprasth Apollo Hospitals • Max Healthcare Institute Ltd. INSURERS • The New India Assurance Co. Ltd. • ICICI Lombard General Insurance Co. Ltd. • IFFCO-TOKIO General Insurance Co. Ltd. • Apollo Munich Health Insurance Co. Ltd. • Future Generali India Insurance Co. Ltd. TPA • Raksha TPA Pvt. Ltd. • E-Meditek (TPA) Services Limited • MD India Healthcare Services (TPA) Pvt. Ltd.

8. Data Standards Group a. Standard Hospital Master and Unique Hospital ID’sb. Information Security list for entities hand health insurance ( minimum technology requirement for licensing and inspection of TPA’s)c. Hospital empanelment data elements d. Electronic Data Interchange standardse. This year we have done a Report on Standards of Data creation, Data Exchange and Data storage for an efficient Electronic data exchange. A very detailed report is there in your foldersAs regards the Payors & Providors GroupThe output was as follows: a) Standard definitions of 20 key terms – ie Deductible, Emergency care, Domicillary treatment, Medical Practitioner etc… b) Standard Pre authorisation and Standard Claim formsc) Standardisation of Transactional interfaces of Pre Authorisation, Claims and empanelment forms d) Customer Information Sheet – Key information on the policy in simple language to be attached with the policye) Curriculum was developed for Underwriting Training and capacity development f) An approach paper was developed for Sustainable Group Health pricing g) Dispute resolution Mechanism h) Design of Health insurance Council i) Trends of medical expenses in India This year the groups worked on a discussion paper on Senior Citizen Health Insurance as well as a discussion paper on Universal Health Cover in IndiaThe data standards and Payor & Provider group is Chaired by Mr Bhargav Dasgupta – Managing Director of ICICI Lombard- Shri Segar Sampath – DGM New India Insurance Company led the Senior Citizen Group- ShriSrikanthCharan – Vice President – IFFCO- Tokio insurance lead the Data standards team - Dr Nishant Jain – Advisor - Social Security, GIZ; led the Universal Health Insurance Group Communication & Awareness group has been working and detailing 1. Communication Content Development2. Approach to reaching out to the uninsured3. Health Insurance Buyers Guide4. Creating Consumer Awareness about health Insurance and Segment specific approach. This year a comprehensive detailed communication has been developed. The group has had presentations from many agencies. We are hopeful of launching very soon, a comprehensive Communication and Awareness campaign. This year, the group is Chaired by MrAnotony Jacob Managing Director Apollo Munich Health Insurance.

9. Recommendations • As regards the Payors & Providors GroupThe output was as follows: a) Standard definitions of 20 key terms – ie Deductible, Emergency care, Domicillary treatment, Medical Practitioner etc… b) Standard Pre authorisation and Standard Claim formsc) Standardisation of Transactional interfaces of Pre Authorisation, Claims and empanelment forms d) Customer Information Sheet – Key information on the policy in simple language to be attached with the policye) Curriculum was developed for Underwriting Training and capacity development f) An approach paper was developed for Sustainable Group Health pricing g) Dispute resolution Mechanism h) Design of Health insurance Council i) Trends of medical expenses in India

10. Communication and Awareness • Communication & Awareness group has been working and detailing 1. Communication Content Development2. Approach to reaching out to the uninsured3. Health Insurance Buyers Guide4. Creating Consumer Awareness about health Insurance and Segment specific approach. This year a comprehensive detailed communication has been developed. The group has had presentations from many agencies. We are hopeful of launching very soon, a comprehensive Communication and Awareness campaign. This year, the group is Chaired by MrAnotony Jacob Managing Director Apollo Munich Health Insurance.