Telemedicine, online consultation to be covered amid COVID-19. How it works

Starting from October, the telemedicine consultation will be covered under health insurance policies. The Insurance Regulatory and Development Authority of India (IRDAI) has asked the insurer to allow claim settlement for telemedicine consultation wherever normal consultation with a medical practitioner is allowed in the terms and conditions of the policy contract.

In the wake of coronavirus pandemic, people are preferring online consultation with doctors than going for a regular check up at hospitals. Many hospitals have started offering nursing services at the homes of patients to maintain amid pandemic. This recent move by the insurance regulator will be beneficial for such policyholders.

“Telemedicine has become more prominent in the current times. The health policies that covers consultations through physical visits will need to include consultations over telemedicine as well,” said Krishnan Ramachandran, MD & CEO, Max Bupa Health Insurance.

Commenting on inclusion of telemedicine under health insurance policies, Shanai Ghosh, executive director & CEO, Edelweiss General Insurance said, “Telemedicine offers great convenience to customers by reducing cost and time associated with travel while avoiding risk of contagious infections like COVID-19.”

What is telemedicine?

“The delivery of health-care services, where distance is a critical factor, by all health-care professionals using information and communications technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation, and the continuing education of health-care workers, with the aim of advancing the health of individuals and communities,” according to the guidelines released by ministry of health and family welfare. A Registered Medical Practitioner is entitled to provide telemedicine consultation to patients from any part of India, the guidelines stated.

How it works:

Anyone taking telemedicine consultation from a doctor will be allowed to claim the expenses under health insurance policy, if their medical policy covers for outpatient department (OPD) expenses. If telemedicine consultations are the part of pre or post hospitalisation expenses, the customers can get the costs covered under the health insurance policy.

The insurers are advised to allow telemedicine wherever consultation with a medical practitioner is allowed in the terms and conditions of policy contract, following the telemedicine practice guidelines by the Medical Council of India, the Medical Council of India, IRDAI said. Provision of allowing telemedicine shall be part of claim settlement of policy of the insurers and need not be filed separately with the authority for any modification, it mentioned. However, the norms of sub limits, monthly or annual limits etc. of the product shall apply without any relaxation.

“Coverage for telemedicine is another extremely relevant and welcome change proposed by the IRDAI. While it may not be particularly reflected in the policy wordings but the same will be handled at the time of claim processing,” said Sanjay Datta, chief-underwriting, claims and reinsurance, ICICI Lombard.

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