Health Insurance Guidelines Oct 2020

Regulatory updates regarding health insurance policies

Insurance Regulatory and Development Authority of India (IRDAI) has introduced new guidelines to standardize the terms and conditions under the health insurance policies. These guidelines are aimed at introducing standard wordings for common clauses and exclusions across health insurance policies. These guidelines will benefit the policyholders by bringing in uniformity in the policy terms and help in simplification and ease in understanding of policies.


Some of the significant changes in 
health insurance policies effective from 1st Oct 2020:

  • Standardization of exclusions

Wordings of certain exclusions such as obesity, cosmetic surgery, gender change treatments, breach of law,  sterility and infertility, maternity have been standardized.

Conditions like genetic disorders, mental illness, etc. have been removed from the list of exclusions and will be covered going forward.

 

  • Standardization of general terms and conditions

Certain clauses pertaining to free look period, portability, migration, cancellation, renewal, claim settlement, fraud etc. will be standardized across health insurance policies.

 

  • Change in the list of Non payable items

The list of non-medical expenses has been reduced from the current 95 items to 68 items. Also certain costs pertaining to room charges, procedure and treatment will now be subsumed into the respective charges.

 

  • Inclusion of Modern Treatment Methods & Advancement in Technology

Advanced treatments like robotic surgeries, stem cell therapy will be covered under health insurance policies.

 

  • Norms on Proportionate Deductions

Proportionate deductions will be applicable on the defined associated medical expenses if a person opts a room category higher than eligibility as per policy terms. Proportionate deduction will not be applicable on ICU charges.

 

For any further queries or details, please call us on our toll free number 18002664545 or e-mail us at care@kotak.com or visit the nearest Kotak General Insurance Branch.

 

To renew your policy, please click on the link: https://www.kotakgeneralinsurance.com/renewal

References :

Guidelines

Ref No.

Link

Standardization of exclusions

IRDAI/HLT/REG/CIR/177/09/2019

https://www.irdai.gov.in/ADMINCMS/cms/whatsNew_Layout.aspx?page=PageNo3916&flag=1

Standardization of general terms and conditions

IRDAI/HLT/REG/CIR/152/06/2020

https://www.irdai.gov.in/ADMINCMS/cms/whatsNew_Layout.aspx?page=PageNo4157&flag=1

Change in the list of Non payable items

IRDAI/HLT/REG/CIR/176/09/2019

https://www.irdai.gov.in/ADMINCMS/cms/whatsNew_Layout.aspx?page=PageNo3914&flag=1

Inclusion of Modern Treatment Methods & Advancement in Technology

IRDAI/HLT/REG/CIR/177/09/2019

https://www.irdai.gov.in/ADMINCMS/cms/whatsNew_Layout.aspx?page=PageNo3916&flag=1

Norms on Proportionate Deductions

IRDAI/HLT/REG/CIR/151/06/2020

https://www.irdai.gov.in/ADMINCMS/cms/whatsNew_Layout.aspx?page=PageNo4156&flag=1


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