Learn About the Three Changes in Health Insurance and Its Benefits

• Written by Care Health Insurance

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The Insurance Regulatory and Development Authority of India (IRDAI) had issued three new guidelines related to medical insurance. These guidelines were released in June and are beneficial to the policyholders. It will make medical insurance more consumer-friendly. In the last few years, there has been a lot of awareness related to health insurance in the country. With the help of these guidelines, the insured can avail of the benefits that are introduced by IRDAI. These three guidelines have been made regarding health insurance policies.

They are as follows:

1. Standardization of clauses in the policy of consumers that will help them to understand the rules and compare them with other products.
2. Insurance coverage for telemedicine will be ensured, which is essential at the time of social distancing.
3. To offer user-friendly claim deduction

• For the first guideline, the health insurers have been asked to standardize terms and clauses in their indemnity-based health insurance policies. These clauses will be implemented in every new policy from October from this year, and will be included in existing policies due for renewal from April 1, next year.
• For the second of telemedicine, the Medical Council of India has issued guidelines allowing registered medical practitioners to offer healthcare services with the help of telemedicine. The health insurers have been advised to allow claim settlement for telemedicine consultation, in whatever place normal consultation with a doctor is permitted, subject to the policy terms and conditions.
• The third guideline is regarding the norms on deductions in claims. It will be beneficial for buyers who are willing to choose high-grade hospital rooms.

For example, if you have a health cover of Rs. 5 lakhs with 1% of capping on daily room rent. The maximum amount for a hospital room that you an individual is eligible for is Rs. 5000. However, if someone opts for a room for Rs. 7000 for the treatment, the health insurer would deduct 40% from the claim that includes the room charges and other extra charges as the hospitals raise the billing on all other chargeable expenses.

Conclusion

The new guidelines require ‘associate medical expenses’ in the policy contract to be clearly defined and does not allow the cost of pharmacy and medical devices in this category. The health insurers will not recover expenses towards the proportionate deductions apart from the other ‘associate medical expenses’. The health insurers must ensure that the deductions are not used for the hospitals that do not follow differential billing. Also, they are not allowed to apply proportionate deduction for ICU charges as there are no different categories for it.

The implementation of these guidelines will be applied to new health insurance plans that are filed after October 1, 2020. While for old health insurance policies, the changes can be made with their renewal from April 1, 2021.

This year, there has been a growth in the health insurance segment. People are now looking for the best health insurance policy in India that will be adequate for them. With increasing cases of coronavirus, people are worried about whether their policy will cover them or not. The existing health insurance policies offer treatment for coronavirus, subject to policy terms and conditions.

In these challenging times, it is important to stay indoors and secure yourself with the best health insurance policy in India.

Disclaimer: Plan features, benefits, coverage, and underwriting of claims are subject to policy terms and conditions. Please refer to the brochure, sales prospectus, and policy documents carefully.