Page 60 - Insurance Times February 2021

vi. Dr Khushali P Gambhir, Homoeopathic Physician, decided by the parties in compliance to provisions of
Chennai Regulation 31 of IRDAI (Health Insurance) Regulations,
vii. Dr Manas Kumar Panigrahi, Neurosurgeon, 2016. However, the insurers shall make efforts to have
Hyderabad agreement with health providers on rates for treatment
viii. Dr Arabind Panda, Urologist, Hyderabad of Covid-19 similar to other diseases for which rate
agreements are in place. Also, while entering into such
ix. Dr Bagyam Raghavan, Radiologist, Chennai agreements, the reference rate of GI council can be
x. Dr Pankaj Sharma, IRDAI, Member Convener kept in view for guidance alongwith rates fixed by State
Governments and Union Territory administration, if any
4. Chairperson, IRDAI shall be Chairperson of the and as relevant.
Committee and Member (Non-Life) shall be Vice
Chairperson of the Committee. 3. All the insurers are directed to ensure that the
“Reimbursement claims” under a health insurance policy
5. Terms of reference for the Committee shall be: shall be settled as per the terms and conditions of the
i. To examine the availability of the health insurance respective policy contract. Hence, the insurers shall
products in the country in the light of the need of honor all the health insurance claims as per the terms
the Indian Society and recommend suitable and conditions of the policy contract.
products and processes.
4. Insurers are advised to issue suitable guidelines on this
ii. To suggest approach on coverage of specific disease to all TPAs.
or an area of practice (e.g cardiology) 5. This has the approval of Competent Authority.
iii. To examine the extant health insurance product
structure in terms of policy conditions to protect (D V S Ramesh)
the interest of the policyholders. General Manager (Health)
iv. To develop strategy on treatment protocol or rate Filing of Half-Yearly PoSP Returns in IIB
structure to improve affordability of health
insurance. Portal
Ref. No:IRDA/INT/CIR/PSP/307/2020
v. To examine any other matter relevant to health
insurance sector. Date:30-12-2020

6. The Committee may meet as often as needed and may 1. This has reference to guidelines issued by the Authority
submit separate recommendations on specific issues on Point of Sales Person (POS) vide its Circular Nos. IRDA/
taken up. Int/GDL/ORD/183/10/2015 dt. 26.10.2016, IRDA/LIFE/
7. The tenure of the Committee will be one year. GDL/GLD/222/11/2016 dt. 07.11.2016 No. IRDAI/INT/
CIR/PSP/130/06/2017 dt. 05.06.2017 and No. IRDAI/
8. This has the approval of the Competent Authority.
LIFE/CIR/MISC/215/12/2019 DT.02.12.2019 wherein the
(M. Pulla Rao) sponsoring entities have been advised to submit data
Executive Director, IRDAI pertaining to Point of Sales to the Authority.
2. In order to streamline the process of the submission and
Communication on settlement of health generate MIS reports a provision has been made at https:/
insurance claims against General Insurance /pos.iib.gov.in portal to upload the half yearly data.
Council’s instructions dated 20th June 2020 3. Insurers and insurance intermediaries are therefore
on “Reference Rates for COVID-19” advised to upload the Half yearly data on POS portal
commencing from the financial year 2020-21. The half
IRDAI/HLT/REG/CIR/011/01/2021 yearly data upto September shall be uploaded by

Date:13-01-2021 31.01.2021 and the data upto 31.03.2021 by
30.04.2021. In future the half yearly data upto 30/09
1. Attention is drawn to the Circular ref: “Reference rates shall be uploaded on or before 30/10 and data upto 31/
for COVID-19 treatment” dated 20th June 2020 issued
by General Insurance Council (GIC). 3 by 30/4.
2. In case of “Cashless Claims” under a health insurance (Randip Singh Jagpal)
policy, the claims shall be settled as per the tariff Chief General Manager
The Insurance Times, February 2021