The insurance regulator’s tweaking of some key norms for health insurance will come handy for policyholders while dealing with the Covid-19 pandemic, say insurers.

The Insurance Regulatory and Development Authority of India (IRDAI) had on Thursday asked general insurers to include telemedicine consultation in processing of claims, if the expenses of consultation with a registered medical practitioner are covered under the terms and conditions of the policy contract.

It had also modified health cover product filing norms and directed that insurers need to define the associate medical expenses which will be deducted proportionately if a person opts for a higher room category than the one eligible as per terms and conditions of the policy.

Expenses like pharmacy costs, implant costs, diagnostic costs, etc will not fall under the definition of ‘associate medical expenses’, the IRDAI said. Hence, the proportionate deduction for such expenses will not be applicable along with ICU charges.

These changes will augur well for policy-holders in fighting the Covid-19 pandemic along with dealing with expenses associated with other ailments, feel industry experts.

Good for customers

“This is a welcome move as it will reduce the out of pocket expenses of the customers. Insurers will negotiate with their hospital networks to see that the increase in rates of the associate medical expenses with change in room category are in control so as to benefit the customer,” Bhaskar Nerurkar, Head, Health Claims, Bajaj Allianz General Insurance, told BusinessLine .

According to Shanai Ghosh, CEO and Executive Director, Edelweiss General Insurance, the move “bodes well for customers and is in their best interest.”

“Earlier, if the customer opted for a room that was higher than entitled, there was proportionate deduction on associated medical charges. Now, the IRDAI has advised insurers to be specific about what these medical costs would entail and that pharmacy, diagnostic, consumables and other implants, would not be included under any circumstances,’’ she said.

As the regulator has also said that there will be no deduction for ICU admission, since it is a single category, this move will translate into higher claim size, for insurers, she added.

The new guideline on telemedicine, Ghosh said: “is definitely great for customers”, especially in the current situation, where it may not be possible or even advisable to go in for regular consultations.

Published on June 12, 2020