News Life and Health06 Sep 2018

India:Regulator removes some medical treatments from optional coverage list

06 Sep 2018

The insurance regulator has removed around 10 items, including procedures such as dental, stem cell, infertility and psychiatric treatment, from the list of "optional cover" for health insurance, in what may mean more inclusive healthcare policies for patients.

The IRDAI in a notification on 27 August said that in a partial modification of guidelines on standardisation of health insurance business, some items have been deleted from the list of “items for which optional cover may be offered by insurers”, reports Times of India.

These include dental treatment that does not require hospitalisation; hormone replacement therapy; infertility, subfertility, assisted conception procedures; obesity treatment, psychiatric and psychosomatic procedures; corrective surgery for refractive error; treatment of sexually transmitted diseases; stem cell implantation, etc.

Removing the treatments from the “optional” list, however, does not mean insurers are now liable to insure these procedures.

An IRDAI official told LiveMint, “Insurers will still have the freedom to exclude or include these procedures as per the provisions of the law.”

The IRDAI circular aims to keep the non-payable list focussed only on consumables and non-medical items, and hence has medical procedures and ailments removed.

Mr Puneet Sahni, head, product development, SBI General Insurance, said, “For customers, this circular has no impact because even as the medical procedures and ailments have been removed from the list, the regulator has not explicitly asked the insurers to include them. Insurers, therefore, still have the flexibility to exclude these items."

Non-payable items

The number of non-payable items on the standardised list is  around 200. These are items that are not payable by a health insurance policy. Insurers are free to include some of the items from the list but they cannot add to the list of exclusions. Items on this list range from consumables, non-medical items including toiletries, cosmetics, personal comfort or convenience items to certain elements of room charges and administrative charges.

Mr Shreeraj Deshpande, head, heath insurance, Future Generali India Insurance, said, “Some ailments and procedures had crept into the list of non-payable or optionally covered items. The circular from IRDAI has rectified it.”

While the circular doesn’t push the insurance industry to be more inclusive, the regulator has set up a committee to review exclusions in health insurance and make suggestions on how to make such policies more transparent and inclusive. The committee is expected to submit its report by next month.

The insurance regulator may provide more clarity by issuing a separate order making it binding on insurance companies to include the “removed” procedures in their plans, according to a source.




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