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IRDAI allows Telemedicine to be covered under health insurance policy

The new step taken by IRDAI means that anyone who has been taking telemedicine consultation (consultation online or telephonically) from a doctor will be allowed to claim the expenses under a Health Insurance policy.

Jun 12, 2020 13:28 IST
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The Insurance Regulatory and Development Authority of India (IRDAI) has asked the insurers to allow telemedicine wherever regular medicine consultation has been allowed, in the terms and conditions of medical insurance policies. This step will bring major relaxation to people amid the COVID-19 outbreak.

As per the releases issued by the insurance regulatory body, the insurers have been asked to allow telemedicine as part of the claim settlement of their policies. The move will bring relief to the health insurance policyholders who prefer to consult medical practitioners online or telephonically.

The relaxation announced by IRDAI has become particularly relevant as often the patients with mild coronavirus symptoms have been advised to quarantine themselves and just take precautions at home. This will prevent the spread of disease and prevent hospitals from overcrowding.

What does allowing telemedicine under health insurance policy means?

The new step taken by IRDAI means that anyone who has been taking telemedicine consultation (consultation online or telephonically) from a doctor will be allowed to claim the expenses under a Health Insurance policy that provides policy covers for OPD expenses.

It will mean that all those policies that provide a claim for OPD consultation expenses will now also be covering telemedicine consultation services as part of the claim settlement of their policies.

The customers will be required to check whether they have OPD cover in their health insurance policy, as there are few companies who don’t provide it in the basic policy cover. In these cases, it is mostly available as an add on the cover where the customer has to pay an additional premium to get its benefits.

About Telemedicine:

The Ministry of Health and Family Welfare issued the Telemedicine Practice Guidelines on its website. The guidelines state the delivery of health care services where distance is a critical factor, by all health professionals with the use of treatment and prevention of disease and injuries, communication and information technologies for the exchange of essential information for research and evaluation, diagnosis, and the continuing education of health care providers, in the interest of advancing the health of individuals and communities.

Telemedicine has been making a positive contribution to healthcare at the time of pandemic as the doctors are able to examine their patients without the risk of getting infected and patients can also consult their doctors online or on the telephone without being out in the crowded clinic or hospital.

Guidelines by IRDAI on telemedicine issued to all general and health insurers:

•    ‘Tele Medicine Practice Guidelines’ have been issued by the Medical Council of India on March 25, 2020. It enables registered medical practitioners to provide health care using Tele Medicine.

•    Insurers have also been advised to allow telemedicine wherever consultation with a medical practitioner is allowed in the terms and conditions of the policy contract.

•    The offered telemedicine shall be in compliance with the Telemedicine Practice Guidelines and as amended from time to time.

•    The provision of allowing telemedicine will be a part of the claim settlement of policy of the insurers and will not be allowed to filed separately with the Authority for any modification. However, monthly/annual limits, the norms of sub-limits, etc. of the product will apply without any relaxation.

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