Irda Amends Norms on Health Insurance

Just a couple of days after standardisation guidelines for the health insurance  sector became effective, the Insurance Regulatory and Development Authority announced some amendments on 3 July 2013.

Of the 46 standardised terminologies for health insurance, the regulator has revised 19. Some changes just rectify typographical or grammatical errors.

For instance, the original definition of ‘unproven/experimental treatment’ missed a ‘not’, changing the scope of the rule. The revised definition now reads: “Treatment including drug experimental therapy which is not based on established medical practice in India, is treatment experimental or unproven.”

The amended guidelines also have a few major additions and omissions. The definition of ‘dependent child’ has been deleted from the list of standardised terminologies. So, insurers are now free to interpret this in their own way.

Under the new norms, an establishment registered with the local authorities does not have any minimum in-patient bed requirement. The requirement of having at least 10 in-patient beds in towns (with a population less than 10 lakh) and 15 inpatient beds in other places is mandatory for unregistered hospitals only.

The definition of ‘medical practitioners’ has been expanded to include people registered under the Central Council of Indian Medicine or the Central Council of Homoeopathy or any similar council set up by the government. Portability has also been redefined to exclude switching of plans with the same insurer.

Relaxations have been made for maternity expenses or treatment. Maternity expenses would now mean any medical treatment or expense traceable to childbirth, including caesarean sections during hospitalisation and lawful abortions during the policy period. Earlier, the benefit was restricted to two deliveries or abortions either during the policy term or lifetime of the insured.

On the flip side, expenses incurred before or after deliveries as well as abortions have been excluded from maternity expenses. The term ‘newborn baby’ now includes adopted children.

 

 

 

 

A ‘premium’ relief for diabetes, hypertension

New India Assurance—India’s largest non-life insurer—has decided to stop charging additional premium for those with diabetes and hypertension under its revised health insurance policy. The state-owned insurer has also withdrawn a clause from its policy that excluded cover for ailments caused by tobacco consumption.

The move will come as a relief to a significant chunk of India’s urban population and will also eliminate disputes arising out of wrongful rejection of claims. The company has decided to include tobacco-related ailments because the exclusion was causing hardship to a lot of policyholders and also because it amounted to rejection of claims on account of lifestyle. The new health insurance policy, however, continues to exclude cirrhosis of lever caused by alcoholism.

“Under the new policy there will be no difference in rates for a standard proposal and someone with diabetes or hypertension,” said G. Srinivasan, chairman, New India Assurance. He said that one of the reasons for the decision was the high incidence of people with such conditions. However, the earlier practice of having a four-year cooling period for pre-existing conditions will continue. This means that if a diabetic buys a policy, the coverage for diabetes related hospitalisation will begin only after four years.