Starting October 1, the Indian health insurance industry has seen a major revamp, resulting in health insurance policies becoming far more customer-centric than earlier. Over the last few months, the Insurance Regulatory and Development Authority of India (IRDAI) has announced several modifications to health insurance norms, a process initiated keeping in mind the ongoing COVID-19 pandemic. These changes have now come into force both for new and existing policies.
Impact of standardisation
The implementation of the new guidelines has had a a positive impact on customers. Standardisation of the policy wordings for inclusions, exclusions, waiting periods and most importantly, the terms and conditions, have made health insurance easier for customers to understand and choose a suitable plan.
Standardisation is a great initiative by the regulatory body as it would help customers gain better clarity on what the insurer is covering under the plan they wish to buy. Moreover, the move would bring about uniformity and promote transparency in health insurance plans, which was earlier a major concern for consumers. The inclusion of consultations over telemedicine in policies that cover consultations under OPD is another major milestone as, during tough times such as today when everyone is trying to avoid stepping out of the house unnecessarily, tele-consultations have become prevalent.
With revamped products already available in the market, out-of-pocket expenses of customers are also going down as the insurance firms are now not allowed to recover any expenses towards proportionate deductions other than the defined associated medical expenses.
And for customers worried that standardisation would result in an increase in premiums, the regulator has decided to cap the impact of the changes on premiums.
Key changes
In an attempt to ensure that policyholders get the best available healthcare facilities and treatment across India, the IRDAI has mandated that customers are eligible for all modern treatment methods through a health policy. Under the revamped products, modern procedures shall be covered either as an inpatient or as part of domiciliary hospitalisation or day care treatment in a hospital.
Some prominent procedures for which you can now take treatment for include deep brain stimulation, robotic surgeries, uterine artery embolisation and HIFU, oral chemotherapy and stem cell therapy.
As per the guidelines issued by the regulator, going forward, insurers will not be allowed to recover any expenses towards proportionate deductions other than the defined associated medical expenses from the customers. Expenses that would now not be a part of the associate medical expenses category include the cost of pharmacy, cost of implants and medical devices and cost of diagnostics.
Also, insurance firms have been directed not to apply proportionate deductions in respect of hospitals that do not follow differential billing based on the room category.
Going forward, the definition of pre-existing diseases (PED) has also been modified as per the needs of the customers.
As per the issued guidelines, any disease or ailment that is diagnosed by a physician 48 months before the issuance of the health cover will be classified under PED. This means that all ailments will be covered under a health insurance cover by serving a waiting period of maximum 48 months.
Moreover, the IRDAI has even mandated that insurers must only include permanent exclusions after due consent of the customers. The exclusions shall only be allowed in the category of cases where the policyholder may be denied coverage as per underwriting rules.
The regulator has given customers the provision of paying the premium in easy monthly instalments. This provision, for now, is only available for people who are buying a fresh cover. The premium payment method may vary among monthly, quarterly, half-yearly or yearly payments and a provision is just an option provided to the insurer and not mandatory for all insurers to implement.
Apart from this, policyholders can now even avail of treatment for mental illness under their cover. As per the guidelines on covering mental illness under health cover, insurers cannot deny coverage to policyholders who have used opioids or anti-depressants in the past.
Also, insurance companies cannot deny coverage to people with a proven history of clinical depression, personality or neurodegenerative disorders, sociopathy and psychopathy. While inpatient hospitalisation for mental disorders will be covered under the regular plans, outpatient counselling or therapy will be covered under the OPD benefit.
(The author is Health Business Head, Policybazaar.com)
