The Insurance Regulatory and Development Authority of India (IRDAI) on June 11, 2020, modifies the guidelines on product filing in health insurance business norms on proportionate deductions.
• Considering the deductions, the insurers shall add in associated medical expenses as well so that proportionate deduction can take place. This shall be termed as associated medical expenses in the contract.
• However, associated medical expenses shall not include the cost of pharmacy and consumables, cost of implants and medical devices and cost of diagnostics.
• Insurers shall ensure that associated medical expenses are not added by the hospitals that do not have differential billing system.
• These guidelines shall be applicable to all the health insurers filed on or before October 1, 2020. All the existing health insurance parties shall modify and comply with the guidelines as early as April 01, 2021.
[Circular No. IRDAI/HLT/REG/CIR/151/06/2020]
