Recent updates by the Insurance Regulatory and Development Authority of India (IRDAI) have brought significant changes to health insurance claim processes. Here are the key rule changes:
1) Cashless Claims Anywhere
Previously, you had to pay out-of-pocket at non-network hospitals and then seek reimbursement.
Now, you can file cashless health insurance claims immediately at any hospital, easing financial burdens during hospital stays.
2) Faster Cashless Claim Processing
Insurers must now clear cashless claims within three hours of receiving them from hospitals at discharge, and within one hour for claims made at admission, reducing claim processing delays.
3) Reduced Waiting Period for Pre-Existing Conditions
The waiting period for claiming insurance on pre-existing health conditions has been reduced. Previously four years, now you can claim for these conditions sooner after purchasing the policy.
4) Recognition of Ayush Treatments
Ayush treatments like ayurveda, yoga, unani, siddha, and homoeopathy are now recognized by IRDAI. Claims for these treatments will not be rejected, provided specified conditions are met.
5) Moratorium Period Reduced to 5 Years
Except in cases of fraud, insurers cannot contest claims due to non-disclosure or misrepresentation if you’ve held continuous health coverage for five years, including portability and migration.
6) Use of Multiple Policies for Single Hospitalisation
You can utilize multiple health insurance policies to cover a single hospitalisation. For instance, if your hospital bill amounts to Rs. 12 lakh and you have policies worth Rs. 5 lakh and Rs. 10 lakh, you can combine both to settle the claim.
These updates aim to enhance accessibility, transparency, and efficiency in health insurance claims, providing greater relief and coverage flexibility to policyholders across India.
