Health Insurance New Rules: Big change in health insurance, claim approval will be available in 1 hour, and payment will be made in 3 hours, otherwise the company will pay a fine
Health Insurance New Rules: IRDAI has instructed insurance companies not to limit cashless facilities only to network hospitals. If the policyholder also gets treatment in a non-network hospital, then the company will have to accept the cashless claim.
Health Insurance New Rules: There is a big relief news for health insurance policyholders. Insurance regulator IRDAI (Insurance Regulatory and Development Authority of India) has made a big change in the rules related to health insurance. Now the way for a completely cashless treatment facility has been cleared. That is, if you have a health policy, then the condition of network hospital will no longer be a hindrance. Apart from this, major improvements have also been made in the rules related to claim rejection, policy renewal and disclosure in favor of common people. Let us know about the 7 major changes of IRDAI and their impact—
Now cashless treatment will be available in every hospital
IRDAI has instructed insurance companies not to limit cashless facility only to network hospitals. If the policyholder gets treatment in a non-network hospital, then the company will have to accept the cashless claim. The insurance company can no longer reject the cashless claim by saying “not in the network”.
Decision on cashless claim in just 1 hour, payment in 3 hours
IRDA has clarified that now the insurance company will have to give a decision within 1 hour on the cashless request sent at the time of hospitalization. When the hospital sends the bill after treatment, the company will have to make the payment within 3 hours. If there is a delay in this or the hospital charges an additional amount, then the insurance company will have to compensate for it.
Now the company will not be able to refuse renewal on big claims
Till now, if you have claimed a big amount, then many times the insurance company used to refuse to renew the policy the next time. But under the new rule, renewal cannot be denied on the basis of just making a claim. Unless the policyholder himself demands to increase the coverage, the company cannot adopt the new underwriting process.
Penalty on insurance company if Ombudsman's orders are not followed
If the order of the Insurance Ombudsman comes in favor of the policyholder in an insurance dispute, then the insurance company will have to comply within 30 days. If this is not done, then the company will have to pay a fine of Rs 5000 every day. This system will fix accountability on insurance companies.
Custom policies for every age group and disabled
IRDAI has asked insurance companies to bring such plans, which are made keeping in mind the needs of the elderly, children and disabled. Also, it will now be mandatory to cover OPD (outpatient), day-care and home care treatments. Apart from this, advanced procedures like robotic surgery, organ transplant will also be included.
The process of claim rejection will now be transparent
Now no insurance company will be able to reject a claim by taking a unilateral decision. Now the decision of claim rejection will be taken by a committee of three people, and it will be mandatory to give clear and written reason for rejecting the claim. This will reduce the incidents of arbitrary rejection.
All diseases will be covered if the policy is held for 5 years
If a policyholder keeps the health policy running for 5 years continuously, then after that no disease will be considered out of insurance. That is, coverage of all diseases will become mandatory - even if you change the company. Coverage can be denied only if fraud is proved.
Policy rules will be explained easily
Now all insurance companies will have to give Customer Information Sheet (CIS) to the customer, in which the main points of the policy will be explained in easy language. This will help the common man to understand what is covered in his policy and what is not.
What will be the impact of these changes
These new rules will provide relief to crores of health insurance policyholders across the country. Earlier, insurance companies used to arbitrarily reject claims, problems like network hospital obligation, unclear rules and late payment were common. But now a customer-centric system will be implemented, where transparency, accountability and convenience have been given priority.
Objective of these reforms of IRDAI
To increase customer confidence in the insurance sector
To make health insurance coverage accessible to all sections
To make the process of claim settlement fast and transparent
To motivate insurance companies to innovate
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