InvestorQ : What are the new guidelines of the IRDA on health insurance policy deductions?
Riya Dwivedi made post

What are the new guidelines of the IRDA on health insurance policy deductions?

Answer
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shrinidhi Rajan answered.
1 month ago


IRDAI recently modified guidelines on proportionate deductions under health insurance policies. This is likely to make the claims settlement process simpler and more transparent. These changes are broadly expected to favour the insurance policy holders.

Currently, if a policyholder opts for a medical facility costing higher than eligible, then the insurer does not reimburse the full bill. Now IRDA will reduce proportionate deductions to reduce extra costs for policyholders. Now, insurer will define the maximum amount it will pay as percentage of sum insured.

In addition, the modified regulations also state that the insurance companies will not recover any expenses towards proportionate deductions apart from regular deductions. Insurers will have to ensure that proportionate deduction is not applied for hospitals which do not follow differential billing.

This will benefit customers as it will reduce out of pocket expenses. IRDAI has advised insurers to be specific about what these medical costs would entail. Clearly, pharmacy, diagnostic, consumables and implants will not be included under any circumstances.