Page 58 - Insurance Times March 2024

to find ways to manage their risks and related capital “Expenses incurred for inpatient care treatment under
requirements to optimise their solvency balance sheets. Ayurveda, Yoga and Naturopathy, Unani, Siddha and
Homeopathy systems of medicines is covered up to 100%
Reinsurance may be observed as one of the key capital
management tools available to the insurers/cedants, of Sum Insured, during each policy year as specified in
which also plays a vital role in risk management, allow- the policy schedule”.
ing them to transfer a portion of their risk to other in- 4. There is no change in other norms specified therein.
surers/reinsurers. 5. This Circular will come into force w.e.f 01.04.2024.
In various jurisdictions around the world, many reinsur- 6. This Circular is issued in terms of Section 14(2)(b) of
ance transactions are backed by collaterals to mitigate IRDA Act,1999.
counterparty default risk in respect of the reinsurers.
The amount of collateral required to back reinsurance
transactions depends on the type of reinsurance and Guidelines on providing AYUSH coverage in
the reinsurer’s creditworthiness. Health Insurance policies
It is important to note that the practice of collaterals 31.01.2024
requirements not only protects the interest of the poli- In recent times, AYUSH treatments have garnered increased
cyholders and insurers but also fosters confidence in the popularity and have become an established branch of medi-
market, attracting reinsurers for promoting a healthy cine. Considering the growing demand for AYUSH treatments,
and robust insurance ecosystem. there is a need to consider these treatments at par with
2. In the backdrop of the above, the Authority is actively othertreatments.
considering introduction of collaterals within the Indian Accordingly, all insurers are advised to comply with the fol-
insurance industry, specifically for reinsurance transac- lowing:
tion with Cross Border Reinsurers (CBRs). 1. Insurers shall have a Board approved policy for providing
AYUSH coverage, which interalia, shall include their ap-
An exposure Draft of proposed Guidelines in this regard
is attached in Annexure – A for the comments from the proach towards placing AYUSH Treatments at par with
Insurers / Re-insurers / Stakeholders. other treatments for the purpose of health insurance so
as to provide an option for the policyholders to choose
The feedback / comments / suggestions may be sent treatment of their choice. The policy shall also contain
on e-mail gautam.kumar@irdai.gov.in with a copy to the quality parameters as well as procedure for enroll-
reinsurance@irdai.gov.in in the specified format i.e. ing AYUSH Hospitals/Day Care Centers as network pro-
Annexure – B , within a period of 15 days from the date viders for the purpose of providing cashless facility.
of its publication in the IRDAI website.
2. Insurers shall modify their existing products that contain

Modification in Product for Persons with limitations for AYUSH Treatments and ensure compliance
with above directions.
Disabilities(PWD), Persons afflicted with
3. Insurers shall have adequate controls as well as Standard
HIV/AIDS, and those suffering from Men- Operating Procedures(SOP) for -
tal Illness a. enrolling hospitals into their network;
b. placing necessary clauses in their health services
31.01.2024
agreements with AYUSH Hospitals/Day Care Centers;
1. Reference is invited to IRDAI Circular no: IRDAI/HLT/CIR/ c. standard treatment protocols; and
MISC/58/02/2023 dated 27th February, 2023 on the cap- d. dealing with the possible frauds and abuse of the
tioned subject. system, if any.
2. In order to provide the health insurance policyholders 4. The Insurers shall actively engage with the Core Group
with an equal choice of choosing either Allopathic Treat- of Experts for Insurance Sector constituted by Ministry
ment or AYUSH Treatment, the following minor modifi- of AYUSH, Government of India vide OM No. T.12020/
cations are made in the model product enclosed to the 02/2017 - DCC(AYUSH) dated 04.10.2023 and develop
above circular. required modalities for providing AYUSH Coverage.
3. Clause 4.2. on “AYUSH Treatment” and “AYUSH” referred 5. This circular will come into force w.e.f 01.04.2024.
at clause 11 in Table of Benefits as well as Product Con- This Circular is issued in terms of Section 14(2) (b) of IRDA
struct have been modified and shall be read as under: Act,1999.

52 March 2024 The Insurance Times