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Query regarding Modern Treatment coverage

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04 Jul, 2021 by  Sankhadeep Mazumder

I was recently going through two policies: (1) HDFC ERGO My Health Suraksha and (2) Star Family Health Optima. Modern Treatment coverage is clearly mentioned in the Star policy with respective sub-limits. However, the HDFC ERGO policy has no mention of Modern Treatment coverage and I found Stem Cell harvesting as a procedure that is permanently excluded. As far as I know, IRDA has mandated all indemnity based health policies to cover Modern Treatments. Why then does the HDFC policy make no mention of this even though their other policy Optima Restore has it clearly mentioned. I want to know if My Health Suraksha has Modern Treatment coverage or not. Thank you.

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06 Jul, 2021

Hello Sankhadeep,


Yes, you are right IRDAI has mandated all insurers to cover Modern Treatments in the policies renewed or sold from October 2020 onwards.


If an insurer has not included any list or limits or exclusions in the policy document, then the cover for Modern Treatment in the policy will be unlimited. Insurers cannot apply any limits or exclusions unless they have explicitly mentioned these in the terms and conditions under the policy document.


There is no question of Modern Treatments not being covered by any insurer going forward. Hence, if HDFC Ergo has not included any limitations, waiting periods, scope, or exclusions in their policy document, it is implied that the cover is up to the Sum Insured.


We hope this clarifies.


Regards,

Team Beshak

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10 Jul, 2021

Hey Sankhadeep,


I agree with the assessment of Team Beshak here.


Also, double check with the representative of insurance company for better understanding.


Anuj

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