Modern treatments dilemma

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.

Health Insurance

3 Answer

Post

28 Apr, 2021

Hari Radhakrishnan

Regional Director, Amicus Insurance Broking

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.

1 Comments

28 Apr, 2021

Sonu

Thank you for clearing one doubt. But what if they just put a sub limit on such claims? Since it is not mentioned at the time of purchase we will be at their mercy. So is it ideal to go with a policy where this is well documented compared to those without any mention of it?

29 Apr, 2021

Shailesh Kumar

CEO, Insurance Samadhan

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

1 Comments

30 Apr, 2021

Sonu

Sorry if I'm rude but I don't think you understand what I'm asking. Modern treatment methods are different from alternate treatment. Most of them use robotic surgeries or other latest technologies. With the advancement in technology more & more such treatment will replace the traditional treatments. Hence I am asking for clarity on the same as most insurers haven't mentioned it in their policies. You should read the IRDAI guideline on the same https://www.tataaig.com/knowledge-center/health-insurance/health-insurance-exclusion-to-be-reduced-by-new-irdai-norms.

Mr. Radhakrishnan already clarified that they can't exclude such treatments but the question remains if they can put a limit on such claims even though it is not pre-mentioned in their policies. For example in Max ReAssure there is limit of 1lakh for most robotic surgeries. And in Care Advantage there is no such limit. In these cases we know what we are buying, but what about those where there is no mention of such kind. Can they put such a limit during the time of claims?

Hope I am clearer about what I'm asking.

30 Apr, 2021

Team Beshak

We breathe insurance :)

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

1 Comments

30 Apr, 2021

Sonu

Finally some clarification. Thank you.

Tired of dealing with call centers!

Get a professional advisor for life!

LIFETIME FREE

Rs. 1799