IRDA backs health cover for OPD and childbirth

NEW DELHI: The insurance regulator on Tuesday suggested that health insurance benefits include out patient department ( OPD) in hospitals, including childbirth, and asked state governments to universalize the cover.

At present, health insurance claims are usually settled only on hospitalisation for at least 24 hours. Besides, child birth is not uncovered under almost all health policies. “Health insurance is today limited to just 20% of the market comprising in-patient (surgical) procedures.

This market needs to grow to provide healthcare for all, for which we have to look at models that cover all medical treatment expenses," Insurance Regulatory & Development Authority chairman J Hari Narayan told an industry conference here.

Citing the global experience, Hari Narayan said that government needs to step up allocation for health insurance premium.

Some states such as Andhra Pradesh have already taken the lead and are offering health cover to the poorer section. At the Centre too, the government has been gradually expanding the ambit of Rashtriya Swasthya Bima Yojana.

While universalisation is some distance away, Hari Narayan set October 1 as the new deadline for health insurance portability which will allow policyholders to change their insurer without losing out on any benefits.

Typically, new ailments during the first few years of purchase of a new policy are excluded from claim settlement. IRDA had earlier fixed July 1 as the deadline for ushering in portability in health insurance, a long-pending issue.

Another pending item on the agenda, guidelines for insurance companies to raise funds, is also expected to be finalized by the end of the month.

For life companies, the clause mandating a three-year track record of profitability as a precondition for tapping the capital markets has been removed in the draft guidelines , he said.