Recent updates to health insurance claim rules aim to streamline the process and provide better benefits for policyholders. Here are the top six changes you need to know:
1. Quick Cashless Clearance
Insurers are now required to clear health insurance claims within three hours of receiving them from the hospital at discharge. Additionally, the Insurance Regulatory and Development Authority of India (IRDAI) mandates a one-hour timeframe for clearing claims requests upon admission. This expedited process ensures patients can be admitted and discharged without unnecessary delays, enhancing the overall healthcare experience.
2. Smooth, Contactless Transactions
The adoption of digital payments is another significant update. Policyholders can now make digital, online payments, e-payments, and card payments regardless of the hospital. This development allows for seamless cashless transactions and enables patients to utilize reimbursement benefits more efficiently.
3. Reduced Waiting Period for Pre-Existing Conditions
The waiting period for pre-existing medical conditions has been reduced from four years to three years. This change means that insurers can now claim insurance for pre-existing conditions after three years from the start of the policy. While this improves access to insurance benefits for many, it may also pose challenges for some patients needing immediate coverage for chronic conditions.
4. AYUSH Treatments Unrestricted
Treatments under Ayurveda, Homeopathy, Yoga, and other traditional systems (collectively known as AYUSH) are now free from restrictions. As long as the conditions specified in the insurance policy are met, patients can undergo these treatments for extended periods. This update offers more holistic health care options for those who prefer alternative treatments.
5. Five-Year Non-Denial Rule
If a policyholder has maintained a health insurance plan for five continuous years, including switching between plans, insurers cannot deny claims unless there is fraud involved. This rule applies irrespective of any errors in the disclosure process, providing greater security and peace of mind for long-term policyholders.
6. Claims with Multiple Insurance Policies
Policyholders can now file claims for a single hospitalization with multiple health insurance policies. This change allows for the settlement of claims through various policies, ensuring that patients can maximize their insurance benefits and reduce out-of-pocket expenses.
These updates to health insurance claim rules are designed to improve the efficiency and accessibility of health insurance benefits. By staying informed about these changes, policyholders can make better decisions regarding their health and well-being. Educate yourself and others about these new rules to ensure you can fully leverage the benefits of your health insurance plan.
