How health insurance policyholders can enjoy telemedicine benefit

The Economic Survey 2020-21 has highlighted the adoption of telemedicine in India since the outbreak of Covid-19 pandemic in March last year. To enable access to healthcare services, when the lockdown was imposed in March to contain the spread of the virus, the Ministry of Health and Family Welfare (MoHFW) issued telemedicine practice and guidelines 2020 on March 25, 2020.

In this regard, IRDAI, the insurance regulator, too had advised insurers to allow coverage for telemedicine consultation with a medical practitioner within the terms and conditions of policy contract. Since then, telemedicine has reported strong traction from across the States. According to the survey, eSanjeevaniOPD, a web-based National Teleconsultation Service mobile application (developed by the Government), has recorded almost a million consultations since its launch in April 2020.

Similarly, Practo, another teleconsultation application, mentioned a 500 per cent increase in online consultations (varying from 200 to 700 per cent across different specialties) in three months.

What is telemedicine

In simple words, telemedicine is delivery of health care services by all healthcare professionals using technology for the exchange of health related information, diagnosis, treatment and prevention of diseases and research and evaluation.

A registered medical practitioner is to provide telemedicine consultation to patients from any part of the country, according to the Ministry’s guidelines.

Taking a cue, IRDAI had mandated all health insurers to provide telemedicine consultation as part of their health policy, including Arogya Sanjeevani, the standard health policy. Insurers now not only offer online consultation with doctors but also on-board new customers through telemedicine.

How you can avail

Telemedicine facilities are mostly considered as an alternative, for regular health check-ups at hospitals or for OPD (out-patient department) cover. If your health policy has an in-built OPD cover or opted as rider, you can avail telemedicine services and claim it under OPD.

OPD over usually covers expenses including diagnostic and preventive tests, prosthetics, physiotherapy, pharmacy expenses and dental treatments.

OPD also cover consultation expenses including ayurveda, yoga, naturopathy, siddha and homeopathy.

Health policies of insurers including Max Bupa, Manipal Cigna and ICICI Lombard offer OPD as in-built cover.

As per the IRDAI’s circular, the norms of sub-limits, monthly or annual limits, which are specific to a policy, will apply to telemedicine claims.

Telemedicine services can also be availed for pre- and post-hospitalisation consultations, as it is covered by almost all the health policies.

These services can be availed through the mobile app of the insurer or on a reimbursement basis.

For instance, policyholders of HDFC Ergo and Max Bupa can avail telemedicine services from the list of empanelled doctors available with the insurers through the respective mobile application.

On the other hand, in Manipal Cigna’s ProHealth policy with in-built OPD, policyholders can avail telemedicine services from any online provider such as Practo and Portea. OPD can either be on a cashless basis or on a reimbursement basis.