Your Health Insurance Policy will Care More from Oct 1; IRDAI Directs These Changes

Updated on: 14 Dec 2021 // 3 min read // #mmm news
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From Oct 1, 2020, your health insurance policy will more friendly and caring. Thanks to Insurance Regulatory and Development Authority of India! The IRDAI has issued three welcome changes for health insurance products which will soon be effective from Oct 1, 2020 and make it easier for customers to understand the policy terms and ease out the claim amount.

Let’s understand the implication of these changes below:

1. Standardisation of policy clauses across the industry

The insurance regular has asked all insurance companies to standardise the general terms and clauses in their indemnity-based health insurance contracts. This will make it substantially easier for customers to understand the terms and conditions of different policies by different companies, thereby helping them compare the products at much more ease.

The IRDAI has provided a standardised contract for insurers so that the customers can better understand the terms and make the informed choices.

Some of the points for contract include: material facts to be disclosed by the insured at the time of policy issuance; terms and conditions for settlement of a claim, and policy cancellation terms, clauses regarding migration, porting, renewal and grievances redressal.

2. Inclusion of coverage for telemedicine

In today’s times of social distancing this is particularly a much welcome clause for health insurance policies. The IRDAI has directed insurers to included telemedicine in the contract.

Telemedicine is the remote practice of patient care. These days it has become mandatory for health practitioners to use modern technology to see patients using video-conferencing tools.

In March 2020, at the backdrop of pandemic spread, the Medical Council of India had issued guidelines enabling Registered Medical Practitioners to provide healthcare using telemedicine. Thus, the insurance regular has asked insurer companies to allow claim settlement for telemedicine consultation clearly in the terms and conditions of the contract.

3. Easing up claim deduction rules

The third set of guidelines reduces the unscrupulous deductions in the claims. This will help in cases where the hospital bills run higher than the capping available under the policy.

The Insurance regulator has asked insurance companies to clearly define ‘associate medical expenses’ in the policy contract. The expenses on pharmacy, consumables, implants, medical devices, and diagnostics are not to be clubbed under associated medical expenses.

How will this benefit you? Typically each policy has a capping on per-day hospital room rent and when you breach that limit, the insurer deducts the proportional gap percentage from total hospital bill, that includes room charges, doctor’s consultation and associate medical expenses. But this was unfair practice. With clear distinction of what is associate medical expense and not, the beneficiary will be able to get better claim on the overall hospital expenses.

Also, Insurers can no longer apply proportionate deduction for hospitalisation that does not have differential charges as in case of ICU admissions.

All these alterations will be included in the new as well as old products. All new products purchased after October 1, 2020, and existing covers due for renewal from April 1, 2021 will incorporate these revised terms.

Also Read: List of IRDAI’s Rules for COVID Health Insurance, Policy Renewal, Portability & Senior Citizens