• Thu. Aug 11th, 2022

Irdai authorizes inclusion of 10 additional insurers for medical treatment


The Insurance and Regulatory Authority of India (Irdai), in a circular issued Tuesday, authorized the inclusion of 10 other insurers for medical treatments from its list of optional coverages offered by health insurance companies.

In its guidelines on standardizing health insurance, the insurance regulator has listed various medical procedures and equipment offered in a policy. And, it is optional for companies to offer coverage for certain items and procedures (listed in Chapter 3 of the guidelines). These are part of the “non-payable” aspects of a standard policy.

Health insurance policies mainly cover hospital costs, while the costs of other treatment and ancillary equipment are borne by the insured.

“For an insured, the circular does not change much. Insurers will have to decide if they want to include them. Otherwise, these procedures would be on the exclusion list anyway, ”said Puneet Sahni, head of product development at SBI General Insurance Company.

READ ALSO: Irdai wants provisions for the treatment of mental illnesses, the task of insurers is cut off

The Irdai also deleted some procedures in the circular. These are dental treatments that do not require hospitalization, hormone replacement therapy, infertility, subfertility, assisted reproduction, treatment of obesity, if excluded from the policy, psychiatric procedures and psychosomatic, refractive error corrective surgery, treatment of sexually transmitted diseases, all expenses related to retrovirus or HIV / AIDS, stem cell implantation, surgery and storage, cosmetic treatments and to surgery.

There are 189 items in the optional coverage list, excluding the 10 written off procedures and items.

“Irdai reduced the number of articles by excluding certain articles from the list. We’ll have to wait and see how insurers use it to cover various customer segments and scale their product, ”said Prasun Sikdar, Managing Director and CEO of Cigna TTK Health Insurance Company.

Insurance players could cover these procedures as “add-on” benefits to the existing policy, insurers said.

ALSO READ: Start including mental illness in your health coverage: Irdai to insurers

“With the new products that we may launch, we will have to assess the financial impact of including some of these procedures,” Sahni said.

However, the regulator has not asked companies to include the removed items in standard policies, nor has it mentioned that these items should be offered as “add-ons”. Insurers will seek clarification in the coming days.

From a health insurance standardization perspective, further consideration should be given to whether these elements can be included in the standard product design and whether this would require changes in the design of current products, said Ashish Mehrotra, Managing Director and CEO of Max Bupa Health. Assurance.

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