Introduction: The Insurance Regulatory and Development Authority of India (IRDAI) has issued a circular, Ref: IRDAI/HLT/CIR/PRO/32/1/2024, on 31st January 2024. This circular addresses modifications in health insurance products tailored for Persons with Disabilities (PWD), individuals afflicted with HIV/AIDS, and those suffering from Mental Illness. The changes aim to provide policyholders with an equal choice between Allopathic and AYUSH (Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy) treatments.
Detailed Analysis:
1. Background: The circular builds upon the foundation laid in the previous IRDAI circular, IRDAI/HLT/CIR/MISC/58/02/2023, dated 27th February 2023.
2. Equal Choice for Policyholders: To ensure a fair choice for health insurance policyholders, the modifications focus on AYUSH treatments. The changes affect Clause 4.2 on “AYUSH Treatment” and the reference to “AYUSH” in Clause 11 of the Table of Benefits and Product Construct.
3. AYUSH Treatment Modification: The key modification in the circular is found in Clause 4.2, which now states, “Expenses incurred for inpatient care treatment under Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy systems of medicines are covered up to 100% of the Sum Insured during each policy year, as specified in the policy schedule.”
4. Effective Date: The circular emphasizes that these changes will be effective from 1st April 2024, allowing stakeholders time to adapt to the new norms.
5. Legal Basis: The circular cites Section 14(2)(b) of the IRDA Act, 1999, as the legal foundation for issuing this modification.
Conclusion: IRDAI’s commitment to inclusivity and fairness in health insurance is evident in this circular. By allowing policyholders to choose between Allopathic and AYUSH treatments, the regulatory authority ensures a more personalized and inclusive healthcare approach. These modifications signify a positive step towards addressing the diverse healthcare needs of individuals with disabilities, HIV/AIDS patients, and those battling mental illness. All stakeholders, including general and health insurance companies, are urged to familiarize themselves with these changes and implement them diligently by the stipulated effective date.
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Insurance Regulatory and Development Authority
Ref: IRDAI/HLT/CIR/PRO/32/1/2024 Dated: 31st January,2024
To
All General, Health Insurance Companies (Except ECGC & AIC) and Third Party Administrators
Sub: Modification in Product for Persons with Disabilities(PWD), Persons afflicted with HIV/AIDS, and those suffering from Mental Illness.
1. Reference is invited to IRDAI Circular no: IRDAI/ HLT/ CIR/ MISC/ 58/ 02/2023 dated 27th February, 2023 on the captioned subject.
2. In order to provide the health insurance policyholders with an equal choice of choosing either Allopathic Treatment or AYUSH Treatment, the following minor modifications are made in the model product enclosed to the above circular.
3. Clause 4.2. on “AYUSH Treatment” and “AYUSH” referred at clause 11 in Table of Benefits as well as Product Construct have been modified and shall be read as under:
“Expenses incurred for inpatient care treatment under Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy systems of medicines is covered up to 100% of Sum Insured, during each policy year as specified in the policy schedule”.
4. There is no change in other norms specified therein.
5. This Circular will come into force w.e.f 01.04.2024.
This Circular is issued in terms of Section 14(2)(b) of IRDA Act,1999.
(A. Ramana Rao)
Chief General Manager (Health)
