Thursday, January 28, 2021
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IRDAI forms advisory panel on health cover

Insurance regulator IRDAI has constituted a health insurance advisory committee to examine the availability of products, suggest approach on the coverage of specific diseases, and develop a strategy on treatment protocol or rate structure towards improving affordability of the insurance.

The 10-member committee comprising experts and specialist doctors has been also tasked with examining the extant health insurance product structure in terms of policy conditions to protect the interest of the policyholders. The committee will have the IRDAI chairman and member (non-life) as its chairperson and vice-chairperson, respectively. It will examine the availability of health insurance products in the country in the light of the need of Indian society, and recommend suitable products and processes.

According to the order, constituting the committee, the panel will have a tenure of one year and its terms of reference include suggesting approach on coverage of specific disease or an area of practice (e.g cardiology). Figuring in the committee are doctors from the public and private healthcare sector, including those in senior administrative positions as well a homeopathic physician.

The formation of the committee comes in the backdrop of a increased demand for health insurance since the outbreak of COVID-19 pandemic. On its part, the regulator last year had issued guidelines on standardised health insurance products and also directing insurers to offer standardised products for COVID-19.

Advice TPAs

Separately, in a circular on Wednesday, the regulator cited a June 2020 General Insurance Council communication on reference rates for COVID-19 treatment and advised insurers to issue suitable guidelines on this to all TPAs.

All the insurers are directed to ensure the reimbursement claims under a health insurance policy will be settled as per the terms and conditions of the respective policy contract. Hence, the insurers shall honour all the health insurance claims as per the terms and conditions of the policy contract.

In case of cashless claims, the claims shall be settled as per the tariff decided by the parties in compliance to provisions of Regulation 31 of IRDAI (Health Insurance) Regulations, 2016. However, the insurers need to make efforts to have agreement with health providers on rates for treatment of Covid-19 similar to other diseases for which rate agreements are in place, IRDAI General Manager (Health) D.V.S. Ramesh said in the circular.

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