Page 43 - Insurance Times November 2020

in mind the need to safeguard them, the regulator has now The total deduction made at the time of claim will reduce
asked all general and specialised health significantly. Says Chhabra: “This will reduce the outof-pocket
expenses of customers to a great extent.”
insurers to start covering the cost of telemedicine consultation
in their policies. Says Goel: “Plans with OPD (outpatient Other key changes:
department) covers will benefit from these guidelines.” If your
Another positive step is the introduction of a moratorium
policy does not cover you for OPD expenses, then it will not
period in health insurance. Under the new rules, once a
cover the charges for telemedicine consultation.
customer has paid a premium for eight years, his claim cannot
At the time of purchasing a policy, customers must check be rejected unless it is fraudulent. Says Krishnan
whether it provides an OPD cover. Says Chhabra: “A few Ramachandran, MD & CEO, Max Bupa Health Insurance:
companies don't provide it in their basic cover. In that case, “With the inclusion of the moratorium clause, customers will
one may cover OPD expenses by buying an add-on policy.” want to stay covered for long so that they are able to derive
the optimum benefit from their health policy.”
Proportionate claim deductions:
The guidelines have also brought greater clarity to the
The new rules say that insurers can no longer include within
definition of PEDS. Any disease that was diagnosed 48 months
‘associated medical expenses’ the following items: costs
prior to entering the plan will be considered a PED.
associated with pharmacy and consumables, implants, medical
devices, and diagnostics (see box: What is proportionate
deduction). Says Chhabra: “In future, insurers will not be The guidelines also bring greater uniformity to the list of
allowed to recover expenses towards proportionate diseases excluded from coverage. “Health conditions such as
age-related macular degeneration, mental illnesses, enteral
deductions other than the defined associated medical
expenses.” feedings, internal congenital and genetic diseases will get
covered by health insurance policies,” says Ramachandran.
The regulator has asked insurers to ensure that proportionate
deduction is not applied in case of hospitals that do not follow Also, customers will have to be informed about exclusions and
differential billing based on room category. Insurers will also their consent will have to be obtained. “This will ensure there
not be allowed to apply proportionate deduction to ICU are no unpleasant surprises at the time of a claim,” says Goel.
charges. (Source: BS)

Future Generali India Insurance to Roll Out "Total Health Score"

Considering the higher incidence of mental health issues in India, especially during the on-going pandemic, Future Generali
India Insurance Company Limited (FGII), announced the launch of an online mental health assessment test – Total
Health Score. This unique self-assessment will enable an individual to evaluate the quality of one’s mental well-being.
FGII encourages everyone to take their mental health seriously and emphasises that one’s mental health is as important
as physical health to be healthy inside out.
The Total Health Score is a questionnaire & API based assessment that is designed by practicing therapists and counsellors
who understand the early signs of potential mental health issues. Once the individual completes the assessment s/he
will be attributed a score that outlines the current state of his/her mental health. In addition, s/he will have access to
self-care content to understand & manage various mental health issues like stress, anxiety, depression and other related
concerns. The self-care content is developed by mental health experts specially for Future Generali.
Anup Rau, MD & CEO, Future Generali India Insurance said, “Our objective is to be a lifetime partner for our customers
and demonstrate expertise with a human touch. We can only achieve this if we truly understand India's cultural norms
& constraints and enable some difficult conversations. We all know that mental health is considered a taboo. As a
brand, we want to steer healthy conversations around mental well-being and change people’s approach towards it.
The starting point of this mindset change is to get people to understand that mental health is as important as physical
health and give them quantifiable ways to measure it. Hence, we created the Total Health Score, a simple questionnaire
and API based score that helps quantify your mental health at the time of taking the test.”
Anyone interested in knowing their health score can take this assessment on FGII’s website or use the FG Insure app.

The Insurance Times, November 2020 43