With the number of covid-19 cases rising rapidly in the country, social distancing has become the new normal, which in turn is increasing dependency on technology. In case of less severe illnesses, people are resorting to telemedicine platforms such as Practo, Ask Apollo and iCliniq for online consultation with doctors.
In a bid to offer some relief to such policyholders, the Insurance Regulatory and Development Authority of India (Irdai) on Thursday said all insurers that offer an outpatient department (OPD) cover must pay for the costs of telemedicine as well.
Telemedicine is the usage of electronic or digital media for the distribution of healthcare services, especially when the patient and doctor cannot be physically present with each other. However, note that telemedicine under health insurance will be covered only if the policyholder has opted for an OPD cover. “Most policies don’t include an OPD cover in the base cover. These usually come with fully-loaded plans," said Naval Goel, CEO and founder, PolicyX, an online insurance marketplace.
The regulator in its circular said that the norms of sub-limits, monthly or annual limits, which are specific to a policy will apply to telemedicine claims as well. “Limits on telemedicine will depend on the cover opted by the consumer and will be the same as the limit on OPD consultation in the policy," said Goel.
In another move that will help people save up on out-of-pocket expenses, Irdai said general and standalone health insurers cannot consider the cost of pharmacy and consumables, implants and medical devices, and diagnostics as a part of associated medical expenses, which come under proportionate deductions. The regulator had published the draft guidelines for the same early this year. You can read more about this here.
If there is a sub-limit on rooms and the policyholder occupies a room with a higher tariff, the proportionate deductions, which are applicable, will not include the cost of the listed expenses.
“The regulator has asked insurers to define the associated medical expenses which will be deducted proportionately. Insurers will have to negotiate with the healthcare providers in their network to see that the increase in rates of the associated costs due to change in room category are under control," said Bhaskar Nerurkar, head-health claims, Bajaj Allianz General Insurance Co Ltd.
Until now, when a policyholder would go for a room with higher tariff, the insurer would apply proportionate deduction on all costs. This will now change to a certain extent because consumables, implants, and diagnostics cannot be part of proportionate deductions. “Only the items that are mandatorily covered under consumables will be exempt from the proportionate deductions," said Amit Chhabra, health business head, Policybazaar.com.
Many small-ticket health insurance products such as Arogya Sanjeevani policy have a cap on room rent and with this move, the regulator is trying to lower the burden on policyholders which could come by way of high bills due to proportionate deductions in the three categories, said Chhabra.