How Do the Revised Health Insurance Rules Help to Seek Access for Medical Treatment?

When a person’s health is concerned, a medical condition can devastate them emotionally and financially. It is a tough situation for the person diagnosed as well as their loved ones. During such times of uncertainty, medical insurance acts as a much-needed financial blanket. It ensures that at least the financial burden of one’s health condition is taken care of.

The Insurance Regulatory and Development Authority of India (IRDAI) is a regulatory body for the insurance industry in India. Regarding the health insurance sector, the IRDA has established new standardization guidelines, which further benefit the policyholder.

IRDAI’s new guidelines for health insurance policies and their benefits

IRDAI has introduced some standard guidelines for the health insurance industry in 2020. These guidelines apply to different types of health insurance products that are introduced from October 1st, 2020, and onwards. You can visit the official website of IRDAI for further details.

Rejection of claim

According to the new guidelines, a health insurance company cannot reject the claim of a policyholder if they have renewed their policy without a break for eight years. The 8-year period is known as the “moratorium period.” An insurance company cannot appeal to the IRDAI against such settlements unless the claim of the policyholder is fraud and/or against the exclusion of the policy after the moratorium period. Further, it cannot reject the claim on the grounds of non-disclosure or misrepresentation. This is because the insurance company had eight years to verify the information provided by the policyholder and, hence, could not reject the claim on grounds of non-disclosure or misrepresentation. You can visit the official website of IRDAI for further details. *

Multiple policies

It is possible that a person has bought multiple health insurance policies, say an individual plan, a family health insurance, and the like. If the policyholder prefers to settle the medical claims with a preferred insurance company, the company is liable to settle claims as per the terms and conditions of the policy. If the amount is pending or disapproved by the preferred company, the policyholder can claim it from another insurer, if they have multiple policies. * 

Claim settlement

If your insurance company is delaying your claim settlement, the company is now liable to pay interest on your claim amount. The rate of interest charged will be 2% more than the existing bank rate. The company should settle the claim for medical insurance within 30 to 45 days from the date on which they communicated the last document required to the policyholder. Depending on the type of claim and investigation required, the time duration is different. *

 Inclusion of telemedicine in health insurance

During the COVID-19 pandemic, both health care providers and patients availed themselves of the facility of remote consultations. Online consultation can cost huge sums to the policyholder and further increase their financial burden. Hence, the IRDAI asked health insurance companies to add telemedicine to their coverage wherever applicable. This will ensure that policyholders do not face financial problems while paying hefty fees for their online consultations. You can visit the official website of IRDAI for further details. * 

Health insurance portability

A policyholder can migrate their existing health insurance to a new similar plan if they are not happy with the services provided by the existing insurance company. A policyholder can choose health insurance portability under two circumstances. If the policyholder is migrating to another plan that is offered by their current insurance company or choosing a new plan with a new insurance company. *

* Standard T&C Apply

Insurance is the subject of solicitation. For more details on benefits, exclusions, limitations, terms, and conditions, please read the sales brochure/policy wording carefully before concluding a sale.

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