6 Key Health Insurance Claim Rule Changes You Need To Know: Details Here

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New Delhi: India’s health insurance has seen many changes lately. The Insurance Regulatory and Development Authority of India (IRDAI) has updated several rules about health insurance claims, according to a report by the Economic Times.

Here are the new health insurance claim rules:

1) Cashless claims anywhere

Now you have the ability to file cashless health insurance claims anywhere even at non-network hospitals. Previously, you had to pay out of pocket and then claim for reimbursement after being discharged. Now, you can claim medical fees from the insurer immediately, easing financial burdens during hospital stays. ()

2) Faster Cashless Claim Processing

The IRDAI introduced new rules for faster processing of cashless claims. Now, Insurers must clear claims within three hours of receiving them from the hospital at discharge. The process must be completed within one hour, greatly reducing delays for claims made at the time of admission.

3) Reduced Waiting Period for Pre-Existing Conditions

Previously, if you had a pre-existing health condition when you bought your health insurance you had to wait for four years before you could claim insurance for that condition.

4) Ayush Treatments Recognized by IRDAI

Insurance regulators (IRDAI) now recognize Ayush treatments like ayurveda, yoga, unani, siddha, and homoeopathy. Claims for Ayush treatments won't be rejected as long as specified conditions are met.

5) Moratorium Period Reduced to 5 Years

Except in cases of fraud, your insurer cannot contest any claim for non-disclosure or misrepresentation if you had continuous health plan coverage for five years including portability and migration. Earlier, this period used to be eight years.

6) Multiple Policies for Single Hospitalisation

You can use multiple health insurance policies to cover a single hospitalisation. For instance, if you have two policies worth Rs. 5 lakh and Rs. 10 lakh and your hospital bill is Rs. 12 lakh, you can use both policies to settle the claim.