Health Insurance New Rules: Get quick cashless approvals

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Do you know that the health insurance regulator IRDA wants insurance companies to make medical expenses completely cashless? Now health insurance companies cannot reject a cashless claim stating that the hospital where you underwent treatment was not on the company’s network list. Similarly, IRDA has changed other rules to make it easier for health insurance policyholders. Here are 7 key changes made:

1. Speeding up cashless claim process

   Insurance companies now have to decide on a cashless treatment request within one hour. They must settle cashless claims within 3 hours of receiving the bill. If there is any delay in settlement or if the hospital charges any additional fees, the insurance company will have to compensate for it. Previously, insurance companies had their own rules for making decisions, which often delayed claim settlements. The new rules will expedite the cashless claim process.

2. Ease in policy renewal

   Until now, insurance companies could refuse to renew a policy if a person had made a large claim. Under the new rules, a company cannot deny policy renewal based solely on claims. Moreover, the company cannot perform new underwriting unless you request to increase coverage. The policy terms and conditions purchased will remain unchanged, and the company cannot force changes to your risks during the policy.

3. Penalty for non-compliance with decisions

   Insurance companies must now comply with orders from the Insurance Ombudsman within 30 days. Failure to do so will result in penalties. If the specified amount is not paid within the time limit, the insurance company will have to pay the policyholder Rs. 5000 per day. These measures by IRDA aim to enforce timely implementation of decisions by the Ombudsman.

4. Innovation in insurance products

   Insurance companies must now introduce innovations in their products that cater to all age groups, including coverage for persons with disabilities. New policies should also include coverage for OPD, day-care, and home-care treatments. All advanced surgeries should also be covered. Earlier, many treatments were not covered under various policy types, requiring significant expenses. These changes will be beneficial for policyholders.

5. Simplification of policy disclosures

   IRDA has simplified the rules and conditions of insurance policies to a considerable extent. Insurance companies must provide their customers with a Customer Information Sheet (CIS) containing important policy-related rules and conditions in simple language. This initiative will make it easier for policyholders to understand coverage.

6. Transparency in claim rejection

   Insurance companies will no longer be able to arbitrarily reject claims. Previously, a single person could decide to reject a claim. Now, a committee of three members will decide on claim rejections. The company must also disclose the reason for rejecting a claim, which will reduce the rate of claim rejections.

7. All diseases covered after 5 years

   If a policyholder keeps their policy active continuously for five years, the insurance company must cover all diseases. Even if there have been changes in insurance companies, after five years, the company cannot refuse coverage for any disease unless fraud is proven. The purpose of this initiative is to provide greater security to policyholders regarding the validity of their claims.

Overall, the changes made by IRDA in health insurance will prove to be a significant step in expanding insurance coverage in the country. While it may take some time for the new rules to fully come into effect, it is certain that policyholders will benefit greatly from them.