Know these six modifications it the health insurance claim rules: According to an Economic Times story, the Insurance Regulatory and Development Authority of India (IRDAI) has revised several regulations pertaining to health insurance claims, resulting in recent modifications to the country’s health insurance system.
Which regulations apply to new health insurance claims?
1) Cashless claims for health insurance anywhere
In contrast to the past, when you had to pay out of pocket and then file a claim for reimbursement after being discharged, you can now claim the medical bills from the insurer without having to pay the hospital—even if it is a non-network facility.
2) Time required for cashless claim clearing
To reduce delays, insurers must process claims within three hours after receiving them from the hospital during discharge. Cashless claims must be processed within an hour of admission.
3) Reduction of waiting period for diseases that already exist
In the past, you had to wait four years to be eligible to file a claim for insurance if you had a certain illness or health condition when you purchased your health insurance policy. The waiting time is now only three years long.
4) No restrictions on Ayush therapy
The Insurance regulator (IRDAI) now recognises Ayush treatments, such as ayurveda, yoga, unani, siddha, and homoeopathy. If you meet the requirements, your claim won’t be denied for an Ayush therapy.
5) The five years of moratorium
A health plan that offers portability and migration and offers continuous coverage for five years cannot be challenged by the insurer for failure to disclose information or misrepresentation, unless there is fraud involved. It was eight years earlier during this time.
6) Claims involving many insurers
A claim for a single hospital stay may be submitted under several different health insurance plans. For instance, both policies can be used to pay the claim if you have two policies for Rs. 5 lakh and Rs. 10 lakh and you receive a Rs. 12 lakh medical bill.
