Breaking Down The New Health Insurance Rules You Need to Know!

Six New Health Insurance Rules To Know

These new health insurance rules were introduced to make things easier and less stressful for policyholders. The rules simplify the claims process, reduce financial burdens, provide quicker access to care, and offer more flexibility.

Find out the latest rules introduced by IRDAI.

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• Cashless Everywhere

Some hospitals are not in certain insurers' networks. In such a case, previously, the policyholder had to pay upfront to the hospital. This was incredibly stressful as well as financially straining for policyholders, as they might not have the funds to make the payment. Policyholders could only apply for reimbursement once the treatment was done.

Now, policyholders do not have to worry about hospitals not being under the insurers’ networks. This cashless facility ensures that the bill is directly settled with the hospital without the involvement of the policyholder. This reduces stress and the financial burden on a person, making the process easier and quicker.

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• Reduced Waiting Period for Pre-existing Conditions and Specific Ailments

If a policyholder has a pre-existing medical issue during the purchase of health insurance, the waiting period used to be four years before the insurer started to cover the illness. However, according to the new rule, the policyholder will only have to wait for 3 years before the insurance covers the illness.

This rule helps policyholders get the necessary treatment without having to wait for a longer period of time. They can get the necessary treatment without worrying about the insurance covering it.

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• No Limitations On AYUSH Treatments

AYUSH stands for Ayurveda, Yoga, Unani, Siddha, and Homeopathy. Under the AYUSH treatments, policyholders can get coverage for any of these treatments, which are alternates for allopathic sciences.

According to the new rule, IRDAI has made it mandatory for insurers to have a board-approved policy for AYUSH treatments. This was introduced to make AYUSH treatments on the same level as allopathic treatments. IRDAI mandates this to honour traditional medical practices and to offer a broader spectrum of choices.

• Three-Hour Cashless Claim Clearance

This rule mandates all insurers to clear cashless claims within three hours of discharge. Additionally, the rule also provides a one-hour window to clear cashless claim requests during admission. This means that, during the time of admission, the policyholder’s insurer has only one hour to approve the cashless claim for treatment.

Three-hour cashless claim clearance ensures a fast approval process with minimal delay, helping reduce stress and enhance the overall experience for policyholders.

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• The Moratorium Period Reduced to 5 Years

The moratorium period is also known as the look-back period in insurance. This period is a specific duration during which the insurer cannot reject a claim based on the non-disclosure of pre-existing diseases. This period is only applicable to those policyholders who have been continuously renewing their policy without any break.

Previously, the moratorium period was for eight years; however, now it has been reduced to five years. The change in the period was brought about to enhance policyholders' security and trust in their health insurance plans.

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• Claim With Multiple Insurers

A policyholder can now use multiple insurance policies to cover a single hospitalisation. If a policyholder has more than one health insurance policy, they can combine their coverage to cover the expenses.

Let us understand with the help of an example.

Aman has two insurance policies, with policy A covering 8 lakhs and policy B covering 10 lakhs. His medical bill comes up to Rs. 14 lakh. He can combine policy A and policy B to settle the claim.

Aman can claim 8 lakhs from policy A and 6 lakhs from policy B.

This rule reduces the financial burden on policyholders and helps them claim insurance to cover their medical bills. This will come in extremely handy, especially during expensive medical treatments.

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