health insurance: Telemedicine to be covered under health insurance policy amid coronavirus outbreak: IRDAI – The Economic Times

Clipped from: https://economictimes.indiatimes.com

This move brings relief to medical insurance policyholders who may prefer to consult medical practitioners online or telephonically to avoid going out of their homes or if they are in quarantine themselves due to the coronavirus infection.

In a major relaxation, the Insurance Regulatory and Development Authority of India (IRDAI) has asked insurers to allow telemedicine wherever regular medical consultation is allowed,in the terms and conditions of medical insurance policies. Insurers have been asked to allowed telemedicine as part of the claim settlement of their policies, as per a release issued by the insurance regulator today.

This move brings relief to health insurance policy holders who may prefer to consult medical practitioners online or telephonically to avoid going out of their homes or if they are in quarantine themselves due to the coronavirus infection. Some hospitals have even started offering some nursing services at the homes of patients in order to reduce patients visits for safety and better social distancing.

This relaxation becomes particularly relevant as often patients with mild coronavirus symptoms are advised to just take treatment at home and quarantine themselves. This is aimed at preventing the spread of the disease as well as to prevent overcrowding of hospitals.

What is telemedicine?
According to Telemedicine Practice Guidelines issued by the Ministry of Health and Family Welfare website, “The delivery of health care services, where distance is a critical factor, by all health care professionals using information and communication technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation, and for the continuing education of health care providers, all in the interests of advancing the health of individuals and their communities.”

Amit Chhabra, Head- Health Insurance, Policybazaar.com said that telemedicine is normally considered under out-of-the-pocket expenses and it is always advised to buy a health insurance policy that reduces the cost of out-of-the-pocket expenses by covering OPD charges as well. “Telemedicine is making a very positive contribution to healthcare during the pandemic and is being used in a variety of ways. The benefits of telemedicine during the ongoing COVID-19 pandemic are obvious as the doctors can examine their patients without the risk of getting corona and patients can also see their doctors even during a lockdown without the risk of being in a crowded clinic or hospital,” said Chhabra.

Who can claim for telemedicine?
Anyone taking telemedicine consultation from a doctor will be allowed to claim the expenses under a health insurance policy provided your policy covers for OPD expenses. Chhabra said, “All policies that provide claim for OPD consultation expenses will now also cover telemedicine consultation service as part of the claim settlement of their policies.”

Naval Goel, CEO & Founder of PolicyX.com, said, “Customers should check whether they have OPD cover in their health insurance as a few companies don’t provide it in the basic cover. It’s available as an add-on cover where the customer has to pay an additional premium to get its benefits.”

Here are the guidelines issued by IRDAI on telemedicine for all general and health insurers:
1. Medical Council of India has issued ‘Tele Medicine practice guidelines’ on 25th of March 2020, enabling registered Medical Practitioners to provide Healthcare using Tele Medicine.

2. In the above background, insurers are advised to allow telemedicine wherever consultation with a medical practitioner is allowed in the terms and conditions of policy contract.

3. Telemedicine offered shall be in compliance with the Telemedicine Practice Guidelines dated 25th of March 2020 and as amended from time to time.

4. Provision of allowing telemedicine shall be part of claim settlement of policy of the insurers and need not be filed separately with the Authority for any modification. However, the norms of sub limits, monthly/ annual limits etc. of the product shall apply without any relaxation, as per the guidelines.

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