IRDAI issues draft modified guidelines on product filing in health insurance business

Mar 20, 2020 | by Avantis RegTech Legal Research Team


Industry Specific Compliance

The Insurance Regulatory and Development Authority of India (IRDAI) on March 17, 2020, has issued the draft modified guidelines on product filing in health insurance business. IRDAI vide IRDA/HLT/REG/CIR/150/07/2016 dated July 29, 2016, provided norms on designing of health insurance products.

The followings are the additional norms:-

1. Where as part of product design insurers propose proportionate deductions of the associated medical expenses when a policyholder chooses a higher room category than the category that is eligible as per terms and conditions of the policy, insurers shall define ‘associate medical expenses’ in the terms and conditions of policy contract.

2. The expenses on cost of pharmacy, cost of implants and medical devices, and cost of diagnostics are not allowed to be part of the definition of ‘associate medical expenses’.

3. Insurers shall ensure that proportionate deductions are not applied in respect of the hospitals which do not follow differential billing based on the room category.

4. Insurers are also not permitted to apply proportionate deduction for ‘ICU charges’ as different categories of ICU are not there.

IRDAI invites comments or suggestions, if any, from all the stakeholders on the proposed guidelines before April 02, 2020. The comments or suggestions, if any, may be forwarded to Dr. Pankaj Sharma, Manager at email id. [email protected]

[IRDAI/HLT/REG/CIR/XXX/ 01/2020]


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