Irda revises health insurance standardisation rules

Porting from one health plan to another of same insurer is now out of portability norms

Portability, which was earlier defined as the right to transfer a health insurance policy from one insurer to another or from one plan to another of the same insurer, has been revised to exclude plans of same insurers. According to the amended health insurance standardisation rules by the Insurance Regulatory and Development Authority (Irda), switching from one plan to another of the same insurer has been kept out of the portability definition.

Further, the definition of hospital has been amended wherein norms of having atleast 10 in-patient beds in towns (with a population less than 1 million) and 15 in-patient beds in other places have been relaxed. Irda has now said hospitals can now be registered with the local authorities under the Clinical Establishments (Registration and Regulation) Act, 2010 or under the enactments specified under the Schedule of Section 56(1) of the said Act.

The insurance regulator has also amended the definition of 'newborn baby' to include adopted children. Under the new definition, newborn baby means a baby born during the policy period and is aged between one day and 90 days, both days inclusive. Earlier, this term meant a baby born to the person and their spouse.

Deductible, which is a cost-sharing requirement under a health insurance policy, has now been amended to provide that the insurer will not be liable for a specified amount in case of indemnity policies and for a specified number of days/hours in case of hospital cash policies. Adding to this, it said registered homeopathic practitioners will also be classified as medical practitioners.

For maternity expenses/treatment, too, relaxations have been made. Earlier, the lawful medical termination of pregnancy during the policy period was limited to two deliveries or terminations or either during the lifetime of the insured person. This has now been revised to lawful medical termination of pregnancy during the policy period. However, pre-natal and post natal medical expenses for delivery or termination have been excluded from the maternity expenses category.

Irda has said unproven/experimental treatment would mean treatment including drug experimental therapy, which is not based on established medical practice in India. This was earlier meant to be such therapy which is based on established medical practice in India.