IRDA amends health insurance standardisation rules

Switching from one plan to another of the same insurer has been kept out of the portability definition, IRDA said

July 05, 2013 2:35 IST | India Infoline News Service
The Insurance Regulatory and Development Authority (IRDA) amended the guidelines on standardisation in health insurance on Wednesday.

According to the amended guidelines, switching from one plan to another of the same insurer has been kept out of the portability definition.

Deductible—a cost-sharing requirement under a health insurance policy—has been amended to provide that the insurer will not be liable for a specified amount in case of indemnity policies and for a specified number of days/hours in case of hospital cash policies. Also registered homeopathic practitioners will be classified as medical practitioners.

The definition of hospital has been amended wherein norms of having at least 10 in-patient beds in towns (with a population less than 1 million) and 15 in-patient beds in other places have been relaxed.

According to the regulator, hospitals can now be registered with the local authorities under the Clinical Establishments (Registration and Regulation) Act, 2010 or under the enactments specified under the Schedule of Section 56(1) of the said Act.

The definition of 'newborn baby' has also been amended to include adopted children. Newborn baby means a baby born during the policy period and is aged between one day and 90 days, both days inclusive. Earlier, this term meant a baby born to the person and their spouse.

Relaxations have been made for maternity expenses/treatment. Maternity expenses should include medical treatment expenses traceable to childbirth including complicated deliveries and caesarean sections during hospitalisation. Maternity expenses should also include expenses towards lawful medical termination of pregnancy during the policy period.

The insurance regulator said unproven/experimental treatment would mean treatment including drug experimental therapy, which is not based on established medical practice in India. This was earlier meant to be such therapy which is based on established medical practice in India.

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