Page 33 - Insurance Times April 2020

COVID 19 - IRDA CIRCULARS

Guidelines on handling of claims 3. These instructions are issued under the provisions of
reported under Corona Virus Section 14 (2) (e) of IRDA Act, 1999 and shall come in
to force with immediate effect.
IRDAI/HLT/REG/CIR/054/03/2020
4. This has the approval of the competent authority.
04th March, 2020
(D V S Ramesh)
1. In respect of the products filed and cleared as per the
provisions of Guidelines on product filing in Health General Manager (Health)
Insurance Business (Ref: IRDA/HLT/REG/CIR/150/07/
2016) dated 29th July 2016, where coverage is granted Modifications Guidelines on Standard

for treatment of hospitalization expenses, in order to Individual Health Insurance Product
alleviate the hardships that may be caused to the
policyholders, all claims reported under corona virus IRDAI/HLT/REG/CIR/055/03/2020
shall be handled as per the following norms. 04th March, 2020
i) Where hospitalization is covered in a product,
insurers shall ensure that the cases related to 1. Reference is invited to the Guidelines on Standard
Corona virus disease (COVID-19) shall be Individual Health Insurance Product (Ref: IRDAI/HLT/
expeditiously handled. REG/CIR/001/01/2020 dated 01.01.2020) mandating all
ii) The costs of admissible medical expenses during general and standalone health insurance companies
the course of treatment including the treatment offer Arogya Sanjeevani Policy. In partial modification
during quarantine period shall be settled in of these guidelines, the following norms are issued.
accordance to the applicable terms and conditions 2. In terms of the provisions of Regulation 4(iii) of IRDAI
of policy contract and the extant regulatory (Issuance of e-Insurance Policies) Regulations, 2016
framework. providing policy document in physical form is mandatory

iii) All the claims reported under COVID 19 shall be when policies are issued in electronic form directly to
thoroughly reviewed by the claims review the policyholders. Since features of Arogya sanjeevani
committee before repudiating the claims. policy are common across the industry and as the terms
and conditions of the polciy are already specified by the
2. In order to provide need based health insurance Authority, with the objective of reducing the
coverage, insurers are introducing products for various oprearating costs and to pass on this benefit of reduced
specific diseases including vector borne diseases. For the operational cost to the policyholders by way of
purpose of meeting health insurance requirements of affordable premiums, insurers are allowed to issue the
various sections, insurers are advised to design products policy contract of Arogya Sanjeevani Policy in electronic
covering the costs of treatment for Corona Virus. / digital format. The digital form of the policy contract
may be forwaded through email or a link shall be
provided in the certificate of insurance. However, where
The Insurance Times, April 2020 33