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New Standardization Guidelines By IRDAI For Health Insurance

Medical expenses are increasing day by day and not everyone can afford them. Hence, one should consider buying a health insurance policy to ensure more protection. On the other hand, it is wise to choose a comprehensive plan that will help get coverage during medical emergencies. Anyone who wants to buy a policy from an insurer should check whether it complies with IRDAI rules and regulations. IRDAI is a statutory body that governs all the activities of insurance companies properly. It aims at updating the changes in insurance industries that cater to the needs of customers.

Both insurers and insured should know more about the IRDAI guidelines in detail to ensure smooth transactions. Not only that, by checking out IRDAI’s new guidelines, a policy buyer can select a policy that caters to his/her requirements. IRDAI introduced new guidelines in 2020 and buyers should understand them with more attention. IRDAI New Rules 2020 health insurance will give more ideas to a health plan buyer that will help make the right decision. IRDAI allows policy buyers to invest money based on their choices and budget.

IRDAI Rules for Health Insurance

Let us examine the IRDA Guidelines for Health Claim Settlement:

  1. When a policyholder renews his/her policy within the time limit, then it doesn’t have an exit age.
  2. If an insurer denies an application of a buyer, then it should clarify the reasons for the rejection to him/her in detail.
  3. It is mandatory for insurers to provide a list of medical facilities to policyholders before issuing a plan for submitting the medical reports.
  4. The group health insurance plans are valid only for one year.
  5. An insurance company should justify the premiums charged for individual plans as well as senior citizen plans.
  6. An insurer should provide an alternative to a particular group of people when they want to migrate from one plan to another plan. Moreover, it should provide credits to a policyholder when a person renews his/her policy with no gaps.
  7. The insurance companies should inform policyholders about the terms and conditions when it comes to medical treatments.


Knowing more about IRDAI Standardization Guidelines

The IRDAI standardization guidelines include the following things and policyholders should know more about them properly:

  1. Claim Settlement 

A policyholder should know the IRDAI guidelines for claim settlement in detail that will help make the right decision. An insurance company is liable to pay 2% interest more than the bank’s interest rate on the claim amount in case of a delay. It should settle the claim amount within 30 to 45 days after informing the final document from the insurer. The IRDAI guidelines for health insurance claim settlement enable policyholders to receive amounts with ease. Moreover, they even show ways to process a claim settlement accordingly.

  1. Claim Rejection 

As per the IRDAI guidelines for insurance companies, health insurance companies can’t reject a claim when a policyholder renews his/her policy for 8 years continuously. Apart from that, they can’t deny a claim based on non-disclosure or misrepresentation. The IRDAI has set 8 years for insurers to cross-check the details of policyholders when they want to claim the amount. Therefore, an insurer can’t reject a claim on such grounds.

  1. Telemedicine under a Health Insurance Plan 

The recent Covid-19 pandemic made a significant impact in insurance industries that forced both insurers and insured to choose remote consultations. On the other hand, the fees for online consultations are high and a policyholder can’t afford them. The IRDAI included telemedicine in the coverage process that provides several advantages to doctors and patients.

Benefits for Health Insurance Policyholders

A policyholder should follow the IRDAI claim settlement guidelines properly while purchasing a policy from an insurance company. Listed below are the benefits offered by the new guidelines:

  1. Multiple Policies 

A person can buy multiple policies of the same type depending on his/her requirements. At the same time, he/she knows more about the claim process in detail. It is wise to know the IRDAI rules while claiming the amount. An insured is eligible to claim coverage from a preferred insurance company as per the terms and conditions. Moreover, he/she is eligible to raise the balance amount with another insurer when one insurance company disapproves of a claim.

  1. Portability

Under new IRDAI guidelines, a policyholder can migrate from one plan to another plan when he/she is not satisfied with the services of a company. The timeline for migration is at least 30 days before the date of expiry.

  1. Cashless Claims 

A policyholder can choose cashless claims during emergencies or planned treatment in listed hospitals. He/she is eligible to apply for the claims that will help avoid cash payments. On the other hand, it is important to check whether a cashless claim facility is available in a hospital.

  1. No Claim Bonus 

No claim bonus is a new feature offered by insurance companies allowing a policyholder to get a reward when he/she didn’t claim any amounts within a policy term. It is advisable for a policy buyer to check whether a plan offers this feature or not.

  1. Pre and Post-Hospitalization Expenses 

A health insurance plan provides pre and post-hospitalization expenses with a waiting period of 60 days and 90 days. However, make sure to read the IRDAI new guidelines for health insurance before purchasing a plan. This, in turn, gives ways to claim amounts without any hassles.

The Conclusion

Anyone who wants to buy a new insurance plan can choose online services that will help a lot to invest money depending on their needs. A plethora of options are available for policy buyers in the markets and they should evaluate them carefully. It is important to read reviews of plans and premium rates online which give ways to select a plan that exactly suits a person.

A policy buyer should follow the IRDAI rules and regulations while picking a policy from an insurance company. This will help a lot to overcome disputes and other problems to get peace of mind in the coverage process. Not only that, a policy buyer can focus more on his/her objectives that provide ways to claim the amount for medical expenses with ease.

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