IRDAI modifies rules for pre-existing diseases


The insurance regulator has amended the definition of pre-existing diseases, a move which could lead to a reduction in the claim rejection rates in health insurance. The Insurance Regulatory and Development Authority of India (IRDAI), through a circular dated February 10, 2020, has deleted 'the additional/modified clause' in its current definition of pre-existing diseases.

Last year in September, the regulator had modified the definition of pre-existing diseases (PEDs) to include certain illnesses if diagnosed within three months after purchasing the health insurance policy. This definition was included in the guidelines on standardisation in health insurance released by IRDAI on September 27, 2019.

However, through its circular issued today, the regulator has now deleted this clause. Thus, as per the new definition, no such disease will be treated as PED even if diagnosed within three months, or later, after buying the health insurance policy.

Source – Economic Times

Common portal for health insurance claim settlements on the cards


Regulator aims to usher time-bound settlement of claims and eliminate disparity in charges among diVerent for some common procedures.

The settlement of health insurance claims could soon be a matter of a few clicks, as the Insurance Regulatory and Development Authority of India (Irdai ) is planning a common portal for the process.

The insurance regulator is seeking to bring all stakeholders in the health insurance space — insurers, the insured, as well as hospitals — under one roof with an aim to standardise the claim settlement procedure and ensure payment in a time-bound manner, T L Alamelu, member (non-life), Irdai, said on Friday.

IRDAI has also formed a committee to look into the matter, and the platform will be developed by the Insurance Information Bureau.

“We hope this will bring a paradigm shift in the way claims are settled in health insurance,” Alamelu said. She was speaking at an insurance summit organised by Assocham in Kolkata.

Source – Business Standard

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