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All you need to know about new changes in your health insurance policy

Starting October 1st, 2020, new health insurance rules came into place in the aftermath of the ongoing COVID-19 pandemic. These changes in guidelines of health insurance cover – brought about by the Insurance Regulatory and Development Authority of India (IRDAI) for medical insurance providers – are aimed at making health insurance plans broader and more simplified. 

The new health insurance rules – which have come at a time when the continuous spread of coronavirus has led to the worst contraction in the country’s gross domestic product – range from waiting periods after getting health insurance, to claim rejection and inclusion of more illnesses in the health cover. However, it must be noted by the consumer purchasing health insurance that the premium paid may also go up.

Here are major changes that came into effect from October 1st, 2020:

What illnesses will be covered under the new health insurance plan?

The coverage of health insurance became wider with new rules coming into effect. According to new health insurance rules, permanent diseases falling under the exclusion category have been reduced to seventeen. Hence, more illnesses will now be covered under the health insurance policy. Earlier the exclusion was for the 30 illnesses. This reduction means that your premium might go up.

The new rules, besides Covid-19, will now cover mental illnesses, genetic diseases, psychological illness, neuro disorder, oral chemotherapy, robotic surgery, stem-cell therapy, etc. This will eventually increase demand for premium cover as it is contemplated that health insurance products will see a rise from five to 20 per cent in the premium category. 

Will health insurance cover pre-existing conditions?

Yes, new health insurance rules will now cover pre-existing conditions. The definition of the pre-existing condition under new health insurance rules is as follows: If an illness was diagnosed 48 months ago, and you develop symptoms three months after the insurance, it is categorized as pre-existing.

How to claim health insurance under new rules?

Health insurance claims will have a time period of eight years after paying the premium. In short, there will be no evaluation until eight years once the policy has been taken.

What are the benefits of the new health policy?

  • Decision On A Claim Within 30 Days: The new guidelines make it clear that insurance companies will have to, under certain conditions, settle or reject a claim not more than 30 days from the date of receipt. In case the insurer fails to decide on a claim within the 30 day period, it will be required to pay interest at a rate of 2 per cent above the applicable bank rate on the dues to the policyholder. So, if your claim gets delayed, your insurance company will have to pay an additional amount over-and-above the claim amount.
  • No Rejection After 8 Years: The new rules mandate insurance companies to not reject a genuine claim after a policyholder completes eight years of paying premiums. Insurers will also be not permitted to re-evaluate a policy for which the customer has paid premiums for 8 years.
  • No Reduction in Ratio: Pharmacy, implants, and diagnostics will no longer be associated with medical expenses which means you will get a full claim for the same. However, your claim amount may reduce due to the inclusion of associated medical expenses. This might be seen in the allocation of expenses for hospital room rent packages. No ratio reduction will be made in claims for ICU charges as it will come under the ambit of hospital room rent packages.

How to choose a health insurance company?

If a customer has more than one health insurance plan, they can simply use one and move to the next using the remaining amount from the other company. While shifting to the other health insurance company products, older product waiting periods can be included.

Will telemedicine be included in health policy?

Yes, telemedicine – the practice of caring for patients remotely when the provider and patient are not physically present with each other – will now be part of the health insurance coverage under the new rules. These include medicines before and after treatment, as well those with OPD coverage policy who will now get full claims on telemedicine.

Will existing policies be aligned with changes in new guidelines?

Yes. According to insurance regulator IRDAI, all existing health insurance plans not in compliance with the new guidelines will be modified. It includes all plans renewed during this financial year (from April 1). The new guidelines will apply to all general and health insurance companies.

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