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Who can claim for Telemedicine Consultations under Health Insurance Policy in India?

With no development of the vaccine yet, people are still bound to practice social distancing as it is the only possible way to stay safe in these critical times. Offices are functioning from home, school, and colleges are shut, and those who are ill are resorting to telemedicine. With the onset of the new normal, the technology-driven era has surely made things simpler during the pandemic. The rising number of COVID-19 cases has let people avoid visiting hospitals and clinics. Instead, they are adopting for online consultation with Doctors via platforms like Practo, Ask Apollo, Meddo, and clinic.

To add some relief to the distressed policyholders, the Insurance Regulatory and Development Authority of India (IRDAI) has announced some major reliefs on Thursday. Insurers that offer outpatient departments have now been asked to pay the costs of telemedicine as well.

These guidelines will be applicable to the products that are filed after October 1, 2020. According to the regulator’s circular, if the policy contracts of all the existing health insurance products are not in agreement with the issued guidelines, they shall be modified as and when they are due for renewal, from April 1, 2021.

What is Telemedicine?

 Telemedicine is consulting doctors via electronic or digital media for healthcare services. According to Telemedicine Practice Guidelines by the Ministry of Health and Family Welfare website, ‘The delivery of health care services, where distance is a critical factor, by all health care professionals using information and communication technologies for the exchange of valid information for the diagnosis, treatment, and prevention of disease and injuries, research and evaluation, and for the continuing education of health care providers, all in the interests of advancing the health of individuals and their communities.’

Who can claim for Telemedicine?

 The process is seeking importance, citing the social distancing norms in today’s times. In view of this, policyholders can now take benefits of their insurance cover if they have opted for an OPD cover. This should be considered by the beneficiaries as most of the base cover plans do not cover OPD charges.

The relaxation has provided relief to many policyholders as patients suffering from mild coronavirus symptoms can take treatment at home with the online advisory of the doctors. This move will not only prevent the spread of the disease but will also save a lot of money from the hospital expenses.

According to the regulator, the norms that are applied with sub-limits, monthly or annual limits specific to a policy cover, should be applied to telemedicine claims as well. Naval Goel, CEO and founder, PolicyX, an online insurance marketplace, said, “Limits on telemedicine will depend on the cover opted by the consumer and will be the same as the limit on OPD consultation in the policy.”

In view of providing more relief to the distressed policyholders, IRDAI has also ruled out the consideration of the cost of pharmacy and consumables, implants and medical devices, and diagnostics for general and standalone health insurers. The guidelines for the same were also published by the regulator early this year.

The draft addressed the sub-limit on rooms. If the policyholders employ a room that has a higher tariff, then the applicable proportionate deductions will not include the cost of the listed expenses.

Bhaskar Nerurkar, head of health claims from Bajaj Allianz General Insurance Co Ltd., was quoted as saying “The regulator has asked insurers to define the associated medical expenses which will be deducted proportionately. Insurers will have to negotiate with the healthcare providers in their network to see that the increase in rates of the associated costs due to change in room category are under control.”

Until now, the proportionate deductions were applied to all costs by the insurer when the policyholder occupied room with a higher tariff. This will change with the current change in norms because consumables, implants, and diagnostics cannot be part of proportionate deductions.

Guidelines issued by IRDAI on telemedicine for all general and health insurers

 1. Medical Council of India has allowed registered Medical Practitioners to offer healthcare via telemedicine, as per the circular ‘TeleMedicine practice guidelines’ on March 25, 2020.

2. It states that the insurers have to allow telemedicine and pay the consultation fees of the medical practitioner according to the terms and conditions of the policy contract.

3. Healthcare services offered via telemedicine shall be in compliance with the Telemedicine Practice Guidelines issued on March 25, 2020.

4. Provision of allowing telemedicine needs not to be filed separately. It shall be the part of the claim settlement of the policy of the insurers.

Source of this information is herehttps://www.renewbuy.com/articles/health-insurance/telemedicine-now-covered-under-health-insurance-policies/

IRDA Guidelines websitelink – https://www.irdai.gov.in/ADMINCMS/cms/frmGuidelines_Layout.aspx?page=PageNo4155

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