Health insurance: telemedicine will be covered by the health insurance policy during the coronavirus epidemic: IRDAI

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In a major easing, the Insurance Regulatory and Development Authority of India (IRDAI) has asked insurers to allow telemedicine anywhere regular medical consultation is allowed, under the terms and conditions of medical insurance policies. Insurers have been asked to authorize telemedicine as part of the settlement of claims on their policies, in accordance with a statement released today by the insurance regulator.

This decision brings relief to policyholders who prefer to consult doctors online or by phone to avoid leaving their homes or if they are themselves in quarantine due to the coronavirus infection. Some hospitals have even started offering nursing services to patients’ homes to reduce patient visits for reasons of safety and better social distancing.

This relaxation becomes particularly relevant as patients with mild symptoms of coronavirus are often advised to simply take home treatment and self-quarantine. This aims to prevent the spread of the disease as well as the overcrowding of hospitals.

Dhirendra Mahyavanshi, co-founder of Turtlemint, an InsurTech company, said the technology can be combined to provide continuity of care, diagnosis, follow-up, etc. can be performed on any digital channel chosen by the physician-patient by mutual consent. This will not only save patients from exposure to the virus, but also doctors and other medical staff in the clinic or hospital. “Rural penetration may also increase as people no longer need to travel long distances for examination and consultation. Hospitalization advice via teleconsultation will also be considered valid by insurance companies for claims,” Mahyavanshi said.

What is telemedicine?

According to the telemedicine practice guidelines published by the Department of Health and Family Welfare website, “The provision of health care services, where distance is a critical factor, by all health professionals using information and communication technologies for the exchange of valid information for the diagnosis, treatment and prevention of disease and injury, for research and evaluation, and for the continuing education of health care providers health, all in the interest of advancing the health of individuals and their communities.

Amit Chhabra, Medicare Manager, Policybazaar.com, said telemedicine is normally considered to be personal expense and it is always advisable to purchase a health insurance policy that lowers the cost. personal expenses. by also covering OPD costs. “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 evident as doctors can examine their patients without the risk of contracting corona and patients can also see their doctor even during lockdown without risking being in a clinic or a crowded hospital, ”Chhabra said.

Who can claim telemedicine?

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

Naval Goel, CEO and Founder of PolicyX.com, said, “Customers should check if they have OPD coverage in their health insurance because a few companies don’t provide it in basic coverage. It is available as additional coverage when the customer has to pay an additional premium to obtain its benefits.

Here are the guidelines issued by IRDAI on telemedicine for all general and health insurers:
1. The Medical Council of India released “Telemedicine Practice Guidelines” on March 25, 2020, enabling licensed physicians to provide health care using telemedicine.

2. In the above context, insurers are advised to allow telemedicine whenever medical consultation is permitted under the terms and conditions of the policy contract.

3. The telemedicine offered must be in accordance with the Telemedicine Practice Guidelines of March 25, 2020 and as amended from time to time.

4. The provision allowing telemedicine is part of the insurance policy claims settlement and does not need to be filed separately with the Authority for any modification. However, the norms of sub-limits, monthly / annual limits, etc. of the product will be applied without any relaxation as directed.
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