Insurance Rule Change: What are the 6 New Changes in Health Insurance Claims? Know Here
The Insurance Regulatory and Development Authority of India (IRDAI) made changes to the insurance rule in order to encourage more people to buy health insurance. Now, 6 big changes have been made in health insurance claims by the insurance authority. Let’s know how it will impact the users.
Here are 6 changes in Health Insurance given below:
1. Cashless Claim Facility
Previously, when an individual was admitted to a hospital which is in a non-network area, he could not avail the facility of cashless claim and first pay expenses from his own pocket and later claim the reimbursement only if he get discharged.
Now, the insurance authority provides the facility of Cashless Claims, individuals can make a claim without any tension if he is admitted to a hospital in a non-network area.
2. Waiting period reduced from 4 to 3 years for Pre-existing Diseases/Specific Ailments
The insurance authority has changed the waiting period for covering insurance. If someone is suffering from a disease or specific medical conditions at the time of buying a health insurance or cover, it will covered only after a pre-specified waiting period by the insurer. The waiting period is now reduced to 3 years, earlier the maximum waiting period was 4 years.
3. Clearance of Cashless Claim in 3 Hours
Now, the claim has to be cleared by the insurer within 3 hours after it is received from the hospital during the discharge of the admitted person. The IRDAI (insurance authority) has also notified a window of 1-hour for clearing cashless claim requests or applications at the time of admission. This will help the person in cutting down the delays at the time of admission and discharge from the hospital.
4. No Limit on Ayush Treatments
Irdai has mentioned that insurers should have approved policies by the Board for Ayush coverage without any limitations. This will help in bringing Ayush treatments such as Ayurveda, Yoga, Unani, Siddha and homoeopathy to par with other treatments. Ayush treatment’s claim will not be rejected if the specified conditions are fulfilled.
5. Claims with Multiple Insurers
A person can make a claim with multiple health insurance policies for a single hospitalisation. For example: If a person has two health insurance policies worth Rs.5 lakh and Rs.10 lakh respectively and hospital expenses occur upto Rs.12 Lakh, the person can use both of his policies to settle the claim.
6. Period of Moratorium decreased to 5 Years
The insurance authority has reduced the Moratorium period to 5 Years which means if an individual has had a health plan with continuous coverage for five years which includes portability and migration then the insurer cannot deny any claim on the basis of misrepresentation or non-disclosure except fraud. Earlier, the period was 8 years.
