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10 Health Treatment Removed From Optional Cover BY IRDAI

The insurers will have to decide whether to continue coverage for these treatments or add them to permanent exclusions

  • 10 Sep 2018
  • 2 min read

The Insurance and Regulatory Authority of India (IRDAI) in a recent notification has removed some items from the list of “optional cover” like psychiatric treatment, dental procedures, infertility and stem cell treatment. However, the notification was inconclusive in nature and has only created further ambiguity on whether such removal of items is to facilitate their mandatory cover or not.

In the notification, the IRDAI said in a partial modification of guidelines on standardisation of health insurance business some items have been deleted from the said list of ‘‘items for which optional cover may be offered by insurers’’.

These items mentioned in the IRDAI notification included assisted conception procedure, hormone replacement therapy, infertility, sub-fertility, obesity treatment, dental treatment that do not require hospitalization, treatment of sexually transmitted diseases, psychiatric and psychosomatic procedures, any expense when the patient is found affected with retro virus or suffering from HIV/AIDS, stem cell implantation, corrective surgery for refractive error, surgery and storage and aesthetic treatment and surgery.

The chief product officer of a leading insurance company said, “In the 2016 list of optional cover, there are 199 items. IRDAI has deleted some of these items. Being optional these were not covered by the insurers. Now, the companies have to examine whether they like to cover them or mention them as permanent exclusions. Covering all these in the policies is not easy as it will need product modification and have a pricing impact”.

“IRDAI has corrected an anomaly as these treatments were part of the non-payable items. Now, they can be included in the product design,” said Sanjay Datta, chief underwriting, claims and reinsurance - ICICI Lombard. He added that these items that were not a part of the hospitalisation cover earlier could now be covered as add-ons.


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