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Modern treatments dilemma

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27 Apr, 2021 by  Sonu

According to IRDAI guidelines modern treatments like robotic surgeries can't be excluded. Still most policies have no mention of the same in their wordings. So if I buy insurance and in future need these modern treatments then can the insurance providers deny such claims citing the current policy wordings or what? Also if they are bound to include these then will they put a sub limit then unlike Max bupa reassure where they mentioned it clearly before hand. Very confused regarding this. Hope someone can clear this for me as I want to buy an insurance ASAP.

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Health Insurance

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The IRDA guidelines standardising the exclusions will be applicable to all new health insurance products filed from October 01, 2020. As far as existing products are concerned, the terms and conditions will be modified to comply with the rules upon renewal after April 01, 2021, and onwards.


So any health insurance product that you buy today are fully compliant with the IRDA regulations, relating to modern treatment coverage, whether it is mentioned in the policy or not. There cannot be any deviation in this regard. Hope this clarifies.

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28 Apr, 2021
Sonu
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29 Apr, 2021

Dear Sonu

Interesting question .

You need to differentiate between standard procedures and alternate methods .

Please note that all standard procedures under allopathic include all modern system or advancement and Insurance company accept all procedures .

Alternate system include Ayush or any other system which is not under allopathic approval ..


So insurers need not mention any specific procedures . They accept .

Remember insurance is an indemnity product .if a procedure cost double of normal procedure then insurer would accept normal procedure . They will not accept expensive procedure .

Hope this clarifies

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30 Apr, 2021
Sonu
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30 Apr, 2021

Hey Sonu,


If an insurer does not have a limit mentioned for robotic surgeries in their policy, they cannot apply limits at the time of claims. Every deduction made during a claim has to be justified by a condition mentioned in the policy document issued to the customer.


Insurers can add new limitations in the policy, only after refiling/applying to IRDAI.


Hope this clarifies.


Regards,

Team Beshak

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30 Apr, 2021
Sonu
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