New Health Insurance Guidelines: Insurers Must Offer Products to Cover All Age Groups and Ailments, says IRDAI

The Insurance Regulatory and Development Authority of India (IRDAI) has issued a fresh master circular concerning health insurance protocols. As per the circular, insurers are mandated to process cashless authorizations within a one-hour timeframe upon receiving a request. According to the latest directives from IRDAI, health insurance providers are mandated to offer a comprehensive range of products catering to individuals of all ages and covering various health conditions.

IRDAI has directed insurers to offer products that cater to:

• Individuals of all age groups.
• Individuals with medical conditions, including chronic ailments.
• Comprehensive coverage for all types of treatments, including outpatient department (OPD) expenses.
• Coverage for individuals from all occupations, regions, and categories.

Insurers are mandated to extend coverage to all types of hospitals, including those offering affordable services. Furthermore, they are prohibited from denying coverage in emergency situations. Covering modern treatments, technology advancements.

Insurers are mandated to incorporate Technological Advancements and Treatments into their products. Examples of prevalent treatments/procedures that need to be included, but are not limited to, are:

• Uterine Artery Embolization and HIFU
• Balloon Sinuplasty
• Deep Brain Stimulation
• Oral chemotherapy
• Immunotherapy - Monoclonal Antibody injections
• Intra vitreal injections
• Robotic surgeries
• Stereotactic radio surgeriesBronchial Thermoplasty
• Vaporisation of the prostate (Green laser treatment or holmium laser treatment)
• IONM (Intra Operative Neuro Monitoring)
• Stem cell therapy: Hematopoietic stem cells for bone marrow transplant for hematological conditions.

In a circular dated May 29, the IRDAI announced the release of a new master circular, which supersedes 55 previous circulars. The objective, as stated by IRDAI, is to enhance the empowerment of policyholders and bolster inclusive health insurance initiatives.

The latest circular serves to consolidate details regarding policyholder entitlements within health insurance policies for convenient reference. Additionally, it states strategies aimed at facilitating a smoother, expedited, and stress-free claims process for policyholders, thereby enhancing service standards within the health insurance sector.

“We are committed to aligning our health insurance offerings with the IRDAI's Master Circular on Health Insurance Business. Our goal is to provide policyholders with a wide range of products covering most medical conditions, including pre-existing diseases. We ensure equal treatment options across all lines of medicine, including Allopathy and AYUSH, and we strive to make 100% cashless services available," said Rakesh Jain, CEO of Reliance General Insurance.

Key highlights of the master circular from the insurance regulator

The insurer is required to provide final authorization within three hours upon receiving the discharge authorization request from the hospital. Under no circumstances should the policyholder be delayed in their discharge from the hospital. In case of any delay exceeding three hours, the insurer will cover any additional charges incurred by the hospital from the shareholder's fund.