IRDAI’s New Rules for Health Insurance – Eshwars
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IRDAI’s New Rules for Health Insurance

Authored by Ammu Brigit

The Insurance Regulatory and Development Authority of India (IRDAI) released few guidelines and circulars in relation to health insurance with the intention to bring in uniformity in the health insurance industry and to include certain illness within the cover of health insurance.

Time limit for settlement of insurance claims

IRDAI released Guidelines on Standardisation of General Terms and Clauses in Health Insurance Policy Contracts (hereinafter referred to as “Guidelines”) on 11th June 2020 under the Insurance Act 1938 along with IRDAI (Health Insurance) Regulation 2016 for bring in uniformity in with regard to general terms and clauses in health insurance industry. The Guidelines is applicable to all general and health insurers offering indemnity-based health insurance. Effective from 1st October for all the health insurance filing on or after 1st October 2020, the Guidelines requires the insurers settle or reject a claim within 30 days from the date of receipt of the last necessary document. In case of delay in payment of the claim amount, the health insurance company to pay interest of 2% to the policyholder from the date of receipt of last necessary document. The Guidelines also provides that the insurer cannot reject a claim of a policyholder who has paid a premium for eight years except for proven fraud and permanent exclusions.  The Guidelines also contains provisions regarding multiple polices, termination of policy by the policyholder or the insurers, policy portability, revision of terms of policy contract with prior intimation to the policy holder etc. The Guidelines document is available at   https://www.irdai.gov.in/ADMINCMS/cms/whatsNew_Layout.aspx?page=PageNo4157&flag=1 .

Inclusion of Mental Illness, HIV/AIDS, Physical Disability under Health Insurance Cover

IRDAI through its circular dated 2nd June 2020 informed all insurers to comply with the IRDAI (Health Insurance) Regulation 2016 to comply with HIV and AID Prevention and Control Act 2017 and Mental Healthcare Act 2017 and instructed all insurers to include policies for persons with disabilities, persons affected with HIV/AID and persons with mental illness diseases.

Telemedicine to be covered under Health Insurance

In a circular dated 11th June 2020, IRDAI has asked all insurers to allow telemedicine wherever medical consultation with a medical practitioner is allowed in the terms and conditions of the policy contract and to make telemedicine a part of the claim settlement policy of the insurers. This is pursuant to the release of Telemedicine Practice Guidelines by Medical Council of India on 25th March 2020.

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