Wednesday, Jun 29, 2022
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IRDAI Issues New Guidelines On Standardisation Of Critical Illness In Health Insurance Policies

The modified definitions are for cancers of specified severity, multiple sclerosis with persisting symptoms, and for loss of speech

The Insurance Regulatory and Development Authority of India (IRDAI) has issued a new circular on the standardisation of critical diseases in health insurance products.

The Insurance Regulatory and Development Authority of India (IRDAI) has come out with a new circular on standardisation of critical illnesses as defined in health insurance products.

The modified definitions are for cancers of specified severity, multiple sclerosis with persisting symptoms, and for loss of speech.

For Cancers Of Specified Severity

According to the notification, the modified definition for cancer of specified severity includes: “A malignant tumour characterised by the uncontrolled growth and spread of malignant cells with invasion and destruction of normal tissues. This diagnosis must be supported by histological evidence of malignancy. The term cancer includes leukaemia, lymphoma and sarcoma.”

According to the notification, the following are excluded from the definition of cancer of specified severity:

1] All tumours which are histologically described as carcinoma in situ, benign, pre-malignant, borderline malignant, low malignant potential, neoplasm of unknown behaviour, or non-invasive, including but not limited to: Carcinoma in situ of breasts, Cervical dysplasia CIN-1, CIN - 2 and CIN-3.

2] Any non-melanoma skin carcinoma unless there is evidence of metastases to lymph nodes or beyond;

3] Malignant melanoma that has not caused invasion beyond the epidermis;

4] All tumours of the prostate unless histologically classified as having a Gleason score greater than 6 or having progressed to at least clinical TNM classification T2N0M0

5] All Thyroid cancers histologically classified as T1N0M0 (TNM Classification) or below;

6] Chronic lymphocytic leukaemia less than RAI stage 3

7] Non-invasive papillary cancer of the bladder histologically described as TaN0M0 or of a lesser classification,

8] All Gastro-Intestinal Stromal Tumors histologically classified as T1N0M0 (TNM Classification) or below and with mitotic count of less than or equal to 5/50 HPFs;

For Multiple Sclerosis With Persisting Symptoms

For multiple sclerosis with persisting symptoms, the modified definition includes the following: 
 
1] The unequivocal diagnosis of Definite Multiple Sclerosis confirmed and evidenced by all of the following:

A] Investigations, including typical MRI findings which unequivocally confirm the diagnosis to be multiple sclerosis and, B] There must be current clinical impairment of motor or sensory function, which must have persisted for a continuous period of at least 6 months.

2] Neurological damage due to SLE is excluded.

For Loss Of Speech

For loss of speech, the modified definition includes the total and irrecoverable loss of the ability to speak as a result of injury or disease to the vocal cords. The notification further says that the inability to speak must be established for a continuous period of 12 months, and this diagnosis must be supported by medical evidence furnished by an Ear, Nose, and Throat (ENT) specialist.

According to the circular, these modifications shall come into force with immediate effect, adding that all other conditions referred earlier within referred master circular of 2020 shall remain unchanged.
 

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