PERSONAL FINANCE FINANCIAL PLANNING
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No one should have to choose between medicine and other necessities. No one should have to use the emergency room every time a child gets sick. And no one should have to live in constant fear that a medical problem will become a financial crisis.
- Brad Henry |
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MEDICLAIM POLICIES IN ELECTRONIC MODES
NO NEED TO ISSUE HEALTH POLICIES IN HARD COPIES : IRDAI
Dated 11.09.2020 : Insurance Regulatory & Development Authority of India ( IRDAI ) has exempted the insurance companies from obtaining proposal forms for Health insurance in in physical format with wet signature of the customer and permitted insurance companies to issue electronic health policies . The exemption is valid up to 31.03.2021
In lieu of obtaining wet signature on the proposal forms from the customers , insurance companies can send completed proposal forms to registered e-mail of the customer and send an OTP to the registered mobile number . If the customer agrees to the proposal , He can use the OTP provided by the company . Similarly health policies are to be sent to registered e-mails of the customer and acknowledgement obtained .
For the IRDAI presss Release dated 10.09.2020 in this regard , CLICK HERE
Dated 11.09.2020 : Insurance Regulatory & Development Authority of India ( IRDAI ) has exempted the insurance companies from obtaining proposal forms for Health insurance in in physical format with wet signature of the customer and permitted insurance companies to issue electronic health policies . The exemption is valid up to 31.03.2021
In lieu of obtaining wet signature on the proposal forms from the customers , insurance companies can send completed proposal forms to registered e-mail of the customer and send an OTP to the registered mobile number . If the customer agrees to the proposal , He can use the OTP provided by the company . Similarly health policies are to be sent to registered e-mails of the customer and acknowledgement obtained .
For the IRDAI presss Release dated 10.09.2020 in this regard , CLICK HERE
RELIANCE HEALTH INFINITY POLICY LAUNCHED
RELIANCE INTRODUCES NEW HEALTH POLICY WITHOUT SUB-LIMITS :
18 08.2020 : Reliance General insurance Company has recently launched a unique health insurance policy called " Reliance Health Infinity Policy " which has no sub-limits on Room rent , Ambulance charges , Ayush cover and Organ Donor expenses . Further discounts are offered for on-line purchase , longer term policies , policy renewal and for the existing customers of the company . One can take a cover from Rs 3.00 lakhs to Rs 1.00 crore either individually or on floater basis. The family floater can have up to 8 persons as members and adults aged between 18 years to 65 years can go for the policy .
For the further details of the policy , inclusions & exclusions , terms & conditions , CLICK HERE
18 08.2020 : Reliance General insurance Company has recently launched a unique health insurance policy called " Reliance Health Infinity Policy " which has no sub-limits on Room rent , Ambulance charges , Ayush cover and Organ Donor expenses . Further discounts are offered for on-line purchase , longer term policies , policy renewal and for the existing customers of the company . One can take a cover from Rs 3.00 lakhs to Rs 1.00 crore either individually or on floater basis. The family floater can have up to 8 persons as members and adults aged between 18 years to 65 years can go for the policy .
For the further details of the policy , inclusions & exclusions , terms & conditions , CLICK HERE
PREMIUMS FOR HEALTH INSURANCE POLICIES : COMPARE BEFORE BUYING
05.08.2020 : To buy a Health insurance policy , you have to pay a fee called premium to the insurance company affront . Now IRDAI has allowed the monthly / quarterly / half yearly payment on the policies . Each insurance policy carries its own premium to be paid for a person of particular age . As each insurance policy was differing in coverage / inclusions / exclusions / co-pay / pre-existing diseases coverage / waiting period etc , it was difficult to compare the premiums of two policies even when the covered amount is same .
Bu during the the last six months , Insurance Regulatory & Development Authority of India ( IRDAI ) has come up with three standard policies to be mandatorily issued by all general and health insurance companies that deal in Health insurance . The three policies are
1. Arogya Sanjeevani Policy 2. Corona Kavach Policy . 3 Corona Rakshak Policy .
Terms of each policy is well defined by IRDAI and hence will carry the same features for the policies issued by different insurance companies . However they are free to quote premiums as they wish and hence IRDAI does not control the premiums to be paid by the customers . Yet it was expected that the premiums would be in the same range for a particular policy for a person of particular age .
To check how the premiums are quoted by different insurers , we compared premiums quoted by six insurance companies for each of the above policy . To our surprise , we found that the variations were huge and some times some companies quoted 10 times the premium quoted by another company for the same coverage . If the variation is so huge among just 6 companies , you can imagine the difference of premium you get if you look in to more and more insurance companies. To go through our survey on premiums , click below on each of the insurance plans .
1. Arogya Sanjeevani Policy Premiums
2. Corona Kavach Policy Premiums
3 Corona Rakshak Policy Premiums
Once you go through the above articles , you will come to know the actual variation in premium of each policy issued by various insurers .
Now it becomes necessary for you to get quotes from as many as possible companies before deciding on a insurance policy . Otherwise you will end up with paying a huge premium .
05.08.2020 : To buy a Health insurance policy , you have to pay a fee called premium to the insurance company affront . Now IRDAI has allowed the monthly / quarterly / half yearly payment on the policies . Each insurance policy carries its own premium to be paid for a person of particular age . As each insurance policy was differing in coverage / inclusions / exclusions / co-pay / pre-existing diseases coverage / waiting period etc , it was difficult to compare the premiums of two policies even when the covered amount is same .
Bu during the the last six months , Insurance Regulatory & Development Authority of India ( IRDAI ) has come up with three standard policies to be mandatorily issued by all general and health insurance companies that deal in Health insurance . The three policies are
1. Arogya Sanjeevani Policy 2. Corona Kavach Policy . 3 Corona Rakshak Policy .
Terms of each policy is well defined by IRDAI and hence will carry the same features for the policies issued by different insurance companies . However they are free to quote premiums as they wish and hence IRDAI does not control the premiums to be paid by the customers . Yet it was expected that the premiums would be in the same range for a particular policy for a person of particular age .
To check how the premiums are quoted by different insurers , we compared premiums quoted by six insurance companies for each of the above policy . To our surprise , we found that the variations were huge and some times some companies quoted 10 times the premium quoted by another company for the same coverage . If the variation is so huge among just 6 companies , you can imagine the difference of premium you get if you look in to more and more insurance companies. To go through our survey on premiums , click below on each of the insurance plans .
1. Arogya Sanjeevani Policy Premiums
2. Corona Kavach Policy Premiums
3 Corona Rakshak Policy Premiums
Once you go through the above articles , you will come to know the actual variation in premium of each policy issued by various insurers .
Now it becomes necessary for you to get quotes from as many as possible companies before deciding on a insurance policy . Otherwise you will end up with paying a huge premium .
TREAT MAKE-SHIFT OR TEMPORARY HOSPITALS AS REGULAR HOSPITALS : IRDAI
Dated 17.07.2020 : Recently various state governments have permitted to build and operate make-shift hospitals or temporary hospitals and operate them in view of surge of covid cases in India and lack of beds in regular hospitals . Now Insurance Regulatory & Development Authority of India ( IRDAI ) has advised the insurance companies to treat claims made under health policies for the hospitalizations in such government permitted temporary or make -shift hospitals as hospitalization in regular hospitals . IRDAI has given following instructions to the insurers :
a) Where a policyholder who is diagnosed as Covid-19 positive is admitted into any such make-shift or temporary hospital on the advice of a medical practitioner or appropriate Government authorities, notwithstanding the definition of hospital specified in the terms and conditions of policy contract, the treatment costs shall be settled by insurers.
b) Where any network provider has set up any such make-shift or temporary hospital, such make-shift or temporary hospital shall be regarded as the extension of the network provider and cashless facility shall be made available.
Further Insurers are advised to expedite settlement of all such claims in accordance to the applicable regulatory framework.
To read IRDAI circular dated 16.07.2020 , CLICK HERE
To know various provisions applicable for covid insurance , CLICK HERE
Dated 17.07.2020 : Recently various state governments have permitted to build and operate make-shift hospitals or temporary hospitals and operate them in view of surge of covid cases in India and lack of beds in regular hospitals . Now Insurance Regulatory & Development Authority of India ( IRDAI ) has advised the insurance companies to treat claims made under health policies for the hospitalizations in such government permitted temporary or make -shift hospitals as hospitalization in regular hospitals . IRDAI has given following instructions to the insurers :
a) Where a policyholder who is diagnosed as Covid-19 positive is admitted into any such make-shift or temporary hospital on the advice of a medical practitioner or appropriate Government authorities, notwithstanding the definition of hospital specified in the terms and conditions of policy contract, the treatment costs shall be settled by insurers.
b) Where any network provider has set up any such make-shift or temporary hospital, such make-shift or temporary hospital shall be regarded as the extension of the network provider and cashless facility shall be made available.
Further Insurers are advised to expedite settlement of all such claims in accordance to the applicable regulatory framework.
To read IRDAI circular dated 16.07.2020 , CLICK HERE
To know various provisions applicable for covid insurance , CLICK HERE
YOUR CLAIM CANNOT BE REJECTED , IF YOU HAVE RENEWED YOUR HEALTH POLICY FOR 8 YEARS : IRDAI
Dated 16.06.2020 : Insurance Regulatory & Development Authority of India ( IRDAI ) has come up with a New standardized Guidelines . As per the same , an insurance company cannot reject your health insurance claim on an insurance policy renewed for 8 years continuously except on account of fraud or permanent exclusions mentioned in the policy . Your insurer has to pay as per policy limits . New guidelines will apply for the renewals on or after 01.04.2021. The guidelines are applicable to both individual and group policies . The notification is applicable to all indemnity based health insurance policies .
However , the policies would be subject to all limits, sub limits, co-payments, deductibles as per the policy contract.
Further if you have many insurance policies , you can chose the insurer with whom you want to make the claim . If the claim settled is less than the claim amount , you may claim the balance from any other insurer you have policies with . It is your right to chose as per the new guideline and the guidelines are applicable from 01.10.2020 for new policies and renewals after 01.04.2021.
Dated 16.06.2020 : Insurance Regulatory & Development Authority of India ( IRDAI ) has come up with a New standardized Guidelines . As per the same , an insurance company cannot reject your health insurance claim on an insurance policy renewed for 8 years continuously except on account of fraud or permanent exclusions mentioned in the policy . Your insurer has to pay as per policy limits . New guidelines will apply for the renewals on or after 01.04.2021. The guidelines are applicable to both individual and group policies . The notification is applicable to all indemnity based health insurance policies .
However , the policies would be subject to all limits, sub limits, co-payments, deductibles as per the policy contract.
Further if you have many insurance policies , you can chose the insurer with whom you want to make the claim . If the claim settled is less than the claim amount , you may claim the balance from any other insurer you have policies with . It is your right to chose as per the new guideline and the guidelines are applicable from 01.10.2020 for new policies and renewals after 01.04.2021.
HEALTH INSURANCE POLICIES TO CONTAIN STANDARDIZED TERMS & CONDITIONS : IRDAI
Dated 13.06. 2020 : Is your claim on health insurance policy is rejected based on a Fine-print in the policy that you have not noticed ? . It is a common reason for the insured person's disappointment with the insurer . Every insurance policy has its own term , conditions and fine-prints which are difficult for the insured to decipher . Terms that you have not read and brought to your notice when you make a claim . Now it is going to change from October month .
Insurance Regulatory & Development Authority of India ( IRDAI ) has come up with a New standardized " Guidelines
on Standardization of General Terms and Clauses in Health Insurance Policy Contracts " which every general insurer and health insurer has to incorporate in their new policy document effective from 01.10.2020 . In case of renewals , new guidelines will apply for the renewals on or after 01.04.2021. The guidelines are applicable to both individual and group policies . The notification is applicable to all indemnity based health insurance policies .
However Insurers are allowed to incorporate other general terms and clauses in the policy as per the specific policy terms in order to ensure an informed choice to the prospects/insured persons. . Hence one has to necessarily read all the terms and conditions before purchasing any insurance policy and be aware of the limitations of the policy .
KEY CLAUSES IN THE GUIDELINES :
Claim Settlement (provision for Penal Interest)
i. The Company shall settle or reject a claim, as the case may be, within 30 days from the date of receipt of last necessary document.
ii. In the case of delay in the payment of a claim, the Company shall be liable to pay interest to the policyholder from the date of receipt of last necessary document to the date of payment of claim at a rate 2% above the bank rate.
iii. However, where the circumstances of a claim warrant an investigation in the opinion of the Company, it shall initiate and complete such investigation at the earliest, in any case not later than 30 days from the date of receipt of last necessary document. In such cases, the Company shall settle or reject the claim within 45 days from the date of receipt of last necessary document.
Multiple Policies
i. In case of multiple policies taken by an insured person during a period from one or more insurers to indemnify treatment costs, the insured person shall have the right to require a settlement of his/her claim in terms of any of his/her policies. In all such cases the insurer chosen by the insured person shall be obliged to settle the claim as long as the claim is within the limits of and according to the terms of the chosen policy.
ii. Insured person having multiple policies shall also have the right to prefer claims under this policy for the amounts disallowed under any other policy / policies even if the sum insured is not exhausted. Then the insurer shall independently settle the claim subject to the terms and conditions of this policy.
iii. If the amount to be claimed exceeds the sum insured under a single policy, the insured person shall have the right to choose insurer from whom he/she wants to claim the balance amount.
iv. Where an insured person has policies from more than one insurer to cover the same risk on indemnity basis, the insured person shall only be indemnified the treatment costs in accordance with the terms and conditions of the chosen policy.
Migration
The insured person will have the option to migrate the policy to other health insurance products/plans offered by the company by applying for migration of the policy at least 30 days before the policy renewal date as per IRDAI guidelines on Migration. If such person is presently covered and has been continuously covered without any lapses under any health insurance product/plan offered by the company,the insured person will get the accrued continuity benefits in waiting periods as per IRDAI guidelines on migration.
Portability
The insured person will have the option to port the policy to other insurers by applying to such insurer to port the entire policy along with all the members of the family, if any, at least 45 days before, but not earlier than 60 days from the policy renewal date as per IRDAI guidelines related to portability. If such person is presently covered and has been continuously covered without any lapses under any health insurance policy with an Indian General/Health insurer, the proposed insured person will get the accrued continuity benefits in waiting periods as per IRDAI guidelines on portability.
Moratorium Period
After completion of eight continuous years under the policy no look back to be applied. This period of eight years is called as moratorium period. The moratorium would be applicable for the sums insured of the first policy and subsequently completion of 8 continuous years would be applicable from date of enhancement of sums insured only on the enhanced limits. After the expiry of Moratorium Period no health insurance claim shall be contestable except for proven fraud and permanent exclusions specified in the policy contract. The policies would however be subject to all limits, sub limits, co-payments, deductibles as per the policy contract.
Other Provisions:
Where these general terms and clauses areused, Insurers shall incorporate the same wordings as prescribed in these guidelines.
Insurers may incorporate other general terms and clauses in the product as per their product design in order to ensure an informed choice to the prospects/insured persons. Insurers may suitably modify the general terms and clauses of the policy contract prospectively based on the Regulations or Guidelines that may be issued by the IRDAI time to time.
To read complete guidelines of the IRDAI , CLICK HERE
TELEMEDICINES WILL BE ALLOWED
Dated 13.06. 2020 : Insurance Regulatory & Development Authority of India ( IRDAI ) has now allowed telemedicine wherever
consultation with a medical praclitioner is allowed in the terms and conditions of policy contract.
Hence insurers have to reimburse tele- consultation fees , in case the insurance policy allows payment towards consultation fees .
To read notification of the IRDAI dated 11.06.2020 in this regard , CLICK HERE
Dated 13.06. 2020 : Insurance Regulatory & Development Authority of India ( IRDAI ) has now allowed telemedicine wherever
consultation with a medical praclitioner is allowed in the terms and conditions of policy contract.
Hence insurers have to reimburse tele- consultation fees , in case the insurance policy allows payment towards consultation fees .
To read notification of the IRDAI dated 11.06.2020 in this regard , CLICK HERE
IRDAI RESTRICTS DEDUCTIONS ON HOSPITALIZATION CHARGES
Dated 12.06. 2020 : Insurance Regulatory & Development Authority of India ( IRDAI ) has come up with new regulation regarding proportionate reduction of claim amount in case of a policy holder availing hospital rooms higher than the eligible amount .
If you occupy a hospital bed which costs higher than the eligible daily limit under a health insurance policy , Insurance companies not only reduce the additional room rent paid , but also reduce the claim amount on other charges incurred by you .
Now IRDAI with a notification dated 11.06.2020 , has come out with new guidelines on the issue .
According to the notification , insurance companies have to specify in the policy document the services on which the proportionate deductions will be affected in case of a policy holder occupying a room with higher rent than eligible . Further insurance companies cannot deduct any amount for the following :
a. Cost of pharmacy and consumables;
b. Cost of implants and medical devices
c. Cost of diagnostics
d. ICU Charges
Further Insurers shall not recover any expenses towards proportionate deductions other than the defined ‘associate medical expenses’ while processing claims. Insurers shall ensure that proportionate deductions are not applied in respect of the hospitals which do not follow differential billing or for those expenses in respect of which differential billing is not adopted based on the room category. This shall be clearly specified in the policy terms and conditions.
The provisions of these guidelines shall be applicable to the Health Insurance products filed on or after 01st October, 2020. All policy contracts of the existing health insurance products that are not in compliance with these guidelines shall be modified as and when they are due for renewal from 01st April, 2021 onwards.
To read the IRDAI Notifiaction , CLICK HERE
Dated 12.06. 2020 : Insurance Regulatory & Development Authority of India ( IRDAI ) has come up with new regulation regarding proportionate reduction of claim amount in case of a policy holder availing hospital rooms higher than the eligible amount .
If you occupy a hospital bed which costs higher than the eligible daily limit under a health insurance policy , Insurance companies not only reduce the additional room rent paid , but also reduce the claim amount on other charges incurred by you .
Now IRDAI with a notification dated 11.06.2020 , has come out with new guidelines on the issue .
According to the notification , insurance companies have to specify in the policy document the services on which the proportionate deductions will be affected in case of a policy holder occupying a room with higher rent than eligible . Further insurance companies cannot deduct any amount for the following :
a. Cost of pharmacy and consumables;
b. Cost of implants and medical devices
c. Cost of diagnostics
d. ICU Charges
Further Insurers shall not recover any expenses towards proportionate deductions other than the defined ‘associate medical expenses’ while processing claims. Insurers shall ensure that proportionate deductions are not applied in respect of the hospitals which do not follow differential billing or for those expenses in respect of which differential billing is not adopted based on the room category. This shall be clearly specified in the policy terms and conditions.
The provisions of these guidelines shall be applicable to the Health Insurance products filed on or after 01st October, 2020. All policy contracts of the existing health insurance products that are not in compliance with these guidelines shall be modified as and when they are due for renewal from 01st April, 2021 onwards.
To read the IRDAI Notifiaction , CLICK HERE
IRDAI ALLOWS MONTHLY PAYMENT OF HEALTH INSURANCE PREMIUM
Dated 22.04.2020 : In view of the present scenario in the wake of spread of pandemic COVID-19 , Insurance Regulatory & Development Authority of India ( IRDAI ) has allowed ed insurance companies to collect health insurance premiums in instalments .
As per IRDAI notification dated 21.04.2020 , the premium instalment facility may be offered by the insurance companies either as a permanent feature or may be offered as a temporary relief for a period of twelve months (one policy year) in respect of all the health insurance policies that are due for renewal up to 31st March, 2021. Further factors effecting the change of premium mode must be fair and reasonable .
The availability of instalment facility should be duly published on the websites of the insurance companies
To read the IRDAI Notifiaction , CLICK HERE
Dated 22.04.2020 : In view of the present scenario in the wake of spread of pandemic COVID-19 , Insurance Regulatory & Development Authority of India ( IRDAI ) has allowed ed insurance companies to collect health insurance premiums in instalments .
As per IRDAI notification dated 21.04.2020 , the premium instalment facility may be offered by the insurance companies either as a permanent feature or may be offered as a temporary relief for a period of twelve months (one policy year) in respect of all the health insurance policies that are due for renewal up to 31st March, 2021. Further factors effecting the change of premium mode must be fair and reasonable .
The availability of instalment facility should be duly published on the websites of the insurance companies
To read the IRDAI Notifiaction , CLICK HERE
IRDAI ASKS INSURANCE COS TO AUTHORIZE IN TWO HOURS FOR COVID 19
Dated 19.04.2020 : In view of the present scenario in the wake of spread of pandemic COVID-19 , Insurance Regulatory & Development Authority of India ( IRDAI ) has asked insurance companies to expeditiously handle health insurance claims pertaining to COVID -19 as follows :
1. Decision on authorization for cashless treatment shall be communicated to the network provider (hospital) within two hours from the time of receipt of authorization request and last necessary requirement from the hospital either to the insurer or to the TPA whichever is earlier.
2. Decision on final discharge shall be communicated to the network provider within two hours from the time of receipt of final bill and last necessary requirement from the hospital either to the insurer or to the TPA whichever is earlier.
Further insurance companies have been aked to intimate the instructions to their TPAs also .
To read IRDAI Press Release dated 18.04.2020 , CLICK HERE
Dated 19.04.2020 : In view of the present scenario in the wake of spread of pandemic COVID-19 , Insurance Regulatory & Development Authority of India ( IRDAI ) has asked insurance companies to expeditiously handle health insurance claims pertaining to COVID -19 as follows :
1. Decision on authorization for cashless treatment shall be communicated to the network provider (hospital) within two hours from the time of receipt of authorization request and last necessary requirement from the hospital either to the insurer or to the TPA whichever is earlier.
2. Decision on final discharge shall be communicated to the network provider within two hours from the time of receipt of final bill and last necessary requirement from the hospital either to the insurer or to the TPA whichever is earlier.
Further insurance companies have been aked to intimate the instructions to their TPAs also .
To read IRDAI Press Release dated 18.04.2020 , CLICK HERE
CENTRAL GOVERNMENT EXTENDS GRACE PERIOD FOR INSURANCE RENEWAL
Dated 16.04.2020 : In view of lock-down in the wake of spread of pandemic COVID-19 , Finance Ministry has permitted time up to 15th, May 2020 for making renewal payment for health insurance policies and Third party motor insurance which have lapsed / lapsing during lock down period from 25.03.2020 to 03.05.2020 and this will ensure a continued cover and hassle-free claims payment during the grace period.
If you are unable to make payment of your renewal premium on time in view of the prevailing situation in the country as a result of Corona Virus disease (COVID-19), you can make use of the relaxation and pay renewal premium to the insurers on or before the 15th May, 2020 to ensure continuity of the statutory motor vehicle third party insurance cover from the date on which the policy falls due for renewal, so that any valid claim triggered during the grace period can be paid.
For Gazette Notification dated 15.04.2020 , CLICK HERE
Dated 16.04.2020 : In view of lock-down in the wake of spread of pandemic COVID-19 , Finance Ministry has permitted time up to 15th, May 2020 for making renewal payment for health insurance policies and Third party motor insurance which have lapsed / lapsing during lock down period from 25.03.2020 to 03.05.2020 and this will ensure a continued cover and hassle-free claims payment during the grace period.
If you are unable to make payment of your renewal premium on time in view of the prevailing situation in the country as a result of Corona Virus disease (COVID-19), you can make use of the relaxation and pay renewal premium to the insurers on or before the 15th May, 2020 to ensure continuity of the statutory motor vehicle third party insurance cover from the date on which the policy falls due for renewal, so that any valid claim triggered during the grace period can be paid.
For Gazette Notification dated 15.04.2020 , CLICK HERE
ORDINANCE ON HEALTH INSURANCE RENEWAL
Dated 03.04.2020 : If your Health insurance has lapsed on or after 25th, March 2020 and are unable to renew it so far , Relax .
As per ordinance issued by Government of India on 01.04.2020 , “The policy holders whose health insurance policies fall due for renewal during the period on and from the 25th March, 2020 to the 14th April, 2020 and who are unable to make payment of their renewal premium on time in view of the prevailing situation in the country as a result of Corona Virus disease (COVID-19),
are allowed to make such payment for renewal of policies to their insurers on or before the 21st April, 2020 to ensure continuity of the health insurance cover from the date on which the policy falls due for renewal.”.
Hence you may go to the website of the insurance company and renew your policy on-line before 21.04.2020 to get the cover from the date of lapse .
To read Gazette notification dated 01.04.2020 , CLICK HERE
Dated 03.04.2020 : If your Health insurance has lapsed on or after 25th, March 2020 and are unable to renew it so far , Relax .
As per ordinance issued by Government of India on 01.04.2020 , “The policy holders whose health insurance policies fall due for renewal during the period on and from the 25th March, 2020 to the 14th April, 2020 and who are unable to make payment of their renewal premium on time in view of the prevailing situation in the country as a result of Corona Virus disease (COVID-19),
are allowed to make such payment for renewal of policies to their insurers on or before the 21st April, 2020 to ensure continuity of the health insurance cover from the date on which the policy falls due for renewal.”.
Hence you may go to the website of the insurance company and renew your policy on-line before 21.04.2020 to get the cover from the date of lapse .
To read Gazette notification dated 01.04.2020 , CLICK HERE
TO KNOW ALL ABOUT
AROGYA SANJEEVANI PLAN ,
A STANDARD HEALTH INSURANCE POLICY TO BE ISSUED BY ALL INSURANCE COMPANIES , CLICK HERE
PLAN N PROGRESS COMPARES
RETIREE BANKERS HEALTH INSURANCE -
UIIC GROUP INSURANCE VERSUS AROGYA SANJEEVANI PLAN
AROGYA SANJEEVANI PLAN ,
A STANDARD HEALTH INSURANCE POLICY TO BE ISSUED BY ALL INSURANCE COMPANIES , CLICK HERE
PLAN N PROGRESS COMPARES
RETIREE BANKERS HEALTH INSURANCE -
UIIC GROUP INSURANCE VERSUS AROGYA SANJEEVANI PLAN
IRDAI ALLOWS 30 DAYS ADDITIONAL GRACE FOR INSURANCE RENEWAL
Dated 27.03.2020 : In view of lock-down in the wake of spread of pendemic COVID-19 , Insurance Regulatory & Development Authority of India ( IRDAI ) has permitted following relaxations for payment of insurance renewal :
1. In case of Life Insurance policies , insurers are asked to enhance existing grace period of 30 days by another 30 days .
2. In case of Health policies , the insurance companies may condone delay in renewal up to 30 days without deeming it as brake in the policy .
To read IRDAI Press Release dated 23.03.2020 , CLICK HERE
Dated 27.03.2020 : In view of lock-down in the wake of spread of pendemic COVID-19 , Insurance Regulatory & Development Authority of India ( IRDAI ) has permitted following relaxations for payment of insurance renewal :
1. In case of Life Insurance policies , insurers are asked to enhance existing grace period of 30 days by another 30 days .
2. In case of Health policies , the insurance companies may condone delay in renewal up to 30 days without deeming it as brake in the policy .
To read IRDAI Press Release dated 23.03.2020 , CLICK HERE
IRDAI ASKS HEALTH INSURANCE COS TO HANDLE CORONA VIRUS CASES EXPEDITIOUSLY
11.03 .2020 : Insurance Regulatory and Development Authority of India ( IRDAI ) has asked all health insurance companies to expeditiously handle claims submitted for Corona Virus cases ( CO VID 19 ) under health insurance policies covering hospitalization . Following are the guidelines issued by IRDAI on 04.03.2020 :
"
i) Where hospitalization is covered in a product, insurers shall ensure that the cases related to Corona virus disease (COVID-19) shall be expeditiously handled.
ii) The costs of admissible medical expenses during the course of treatment including the treatment during quarantine period shall be settled in accordance to the applicable terms and conditions of policy contract and the extant regulatory framework.
iii) All the claims reported under COVID 19 shall be thoroughly reviewed by the claims review committee before repudiating the claims.
In order to provide need based health insurance coverage, insurers are introducing products for various specific diseases including vector borne diseases. For the purpose of meeting health insurance requirements of various sections, insurers are advised to design products covering the costs of treatment for Corona Virus. "
To read Circular of IRDAI dated 04.03.2020 , CLICK HERE
11.03 .2020 : Insurance Regulatory and Development Authority of India ( IRDAI ) has asked all health insurance companies to expeditiously handle claims submitted for Corona Virus cases ( CO VID 19 ) under health insurance policies covering hospitalization . Following are the guidelines issued by IRDAI on 04.03.2020 :
"
i) Where hospitalization is covered in a product, insurers shall ensure that the cases related to Corona virus disease (COVID-19) shall be expeditiously handled.
ii) The costs of admissible medical expenses during the course of treatment including the treatment during quarantine period shall be settled in accordance to the applicable terms and conditions of policy contract and the extant regulatory framework.
iii) All the claims reported under COVID 19 shall be thoroughly reviewed by the claims review committee before repudiating the claims.
In order to provide need based health insurance coverage, insurers are introducing products for various specific diseases including vector borne diseases. For the purpose of meeting health insurance requirements of various sections, insurers are advised to design products covering the costs of treatment for Corona Virus. "
To read Circular of IRDAI dated 04.03.2020 , CLICK HERE
RELIANCE HEALTH INSURANCE PROHIBITED FROM SELLING NEW POLICIES
08.11.2019 : As per Press Release dated 06.11.2019 of Insurance Regulatory and Development Authority of India ( IRDAI ) , Relaince health Insurance Company Limited is prohibited from selling new health policies and has been directed to transfer all its policy holder's assets and liabilities to reliance General Insurance Co Ltd with effective from 15.11.2019 . Further company has been prohibited from using its assets for all purposes except for settling policy holders claim amount .
The Authority has assured the existing policy holders that all their interests would be adequately protected and all genuine claims would continue to be duly honored.
For IRDAI Press Release . CLICK HERE
08.11.2019 : As per Press Release dated 06.11.2019 of Insurance Regulatory and Development Authority of India ( IRDAI ) , Relaince health Insurance Company Limited is prohibited from selling new health policies and has been directed to transfer all its policy holder's assets and liabilities to reliance General Insurance Co Ltd with effective from 15.11.2019 . Further company has been prohibited from using its assets for all purposes except for settling policy holders claim amount .
The Authority has assured the existing policy holders that all their interests would be adequately protected and all genuine claims would continue to be duly honored.
For IRDAI Press Release . CLICK HERE
INDIA STANDS 145TH AMONG 190 COUNTRIES IN HEALTHCARE ACCESS AND QUALITY
Dated 23.05.2018 : Media reported today that India is ranked 145th among 195 countries studied by an international organization for healthcare and access . Report said that standing of India is much behind neighboring countries like China ,Bangaladesh , Bhutan and Sri Lanka . However it is better than that of Pakistan , Nepal and Afghanistan .
Report also noted that the healthcare access in India has improved in last 25 years ( 1990 to 2016 ) from an index of 24.7 to 41.2 . In India , it is noted that states like Kerala and Goa has better healthcare access compared with national average while states of Uttar Pradesh , Assam are lagging behind .
We observe that access of healthcare has improved in India in last 15 years with improved medical facility and many states offering free healthcare or insurance to the citizens at affordable prices . Case in point is Yashaswani in Karnataka . We have improved our medical facilities in many urban centers and such facilities are attracting many overseas patients on account of affordability compared with their own countries . But sadly such facilities are still not affordable to many Indians of middle class and poorer section . Unless one has sufficient insurance , many may not afford the medical facility they need .
Dated 23.05.2018 : Media reported today that India is ranked 145th among 195 countries studied by an international organization for healthcare and access . Report said that standing of India is much behind neighboring countries like China ,Bangaladesh , Bhutan and Sri Lanka . However it is better than that of Pakistan , Nepal and Afghanistan .
Report also noted that the healthcare access in India has improved in last 25 years ( 1990 to 2016 ) from an index of 24.7 to 41.2 . In India , it is noted that states like Kerala and Goa has better healthcare access compared with national average while states of Uttar Pradesh , Assam are lagging behind .
We observe that access of healthcare has improved in India in last 15 years with improved medical facility and many states offering free healthcare or insurance to the citizens at affordable prices . Case in point is Yashaswani in Karnataka . We have improved our medical facilities in many urban centers and such facilities are attracting many overseas patients on account of affordability compared with their own countries . But sadly such facilities are still not affordable to many Indians of middle class and poorer section . Unless one has sufficient insurance , many may not afford the medical facility they need .
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FORTIS INCIDENCE - AN EYE OPENER
Dated 22.11.2017 : Newspapers / media reported that a girl named Ms Adya who was admitted to Fortis Hospital - Gurugram by her father Mr Jayant Singh recently for complications from dengue fever was billed by the hospital for more than Rs 16 lakhs for a treatment given for 15 days in ICU of the hospital . It is also reported that girl didn't survive in spite of costly medical treatment she got . Though the father had insurance for Rs 10 lakhs , he has to make arrangement for additional payment for the bill . It is reported that Haryana government will investigate the matter with regard to allegations of excess charges . The hospital authorities maintained that the entire treatment and billing was as per protocol .
As the news spread in the media , the eyes of media and public opened up on the prohibitive cost of private health care in India . We could hear debate ranging over various matters related to health care system in India . We analysed that major concerns raised were with following aspects of the health care .
1. Quality of public sector hospitals
2. Cost of private sector hospitals and a need to regulate them .
3. Ethics of corporate hospitals run on commercial mode and of doctors .
4. Role of governments in controlling hospitals
5. Regulations like KPME Act , though which Karnataka government is trying to regulate private hospitals .
The above aspects are very relevant these days and require deep debates and action by governments , doctors and hospitals . Collective action by governments , medical associations , hospitals and doctors may help the common man getting medical attention in a cost effective way . However ,as for as we are concerned , we individually have to take appropriate steps to safeguard ourselves against unforeseen medical calamity that may happen and the result of the same on our lives including financial disaster . While medical calamity make us lose our beloved ones , financial mess that may create may ruin the lives of living members of the family . We may take precautions in our daily life to save ourselves from health problems by changing our life style . But we may have to fight against accidents and unexpected diseases . Further we may have to ensure ourselves financially secure for any need in such situations . Some of the points below may be worth noting :
1. We are more and more dependent on private hospitals and doctors these days .
2. The cost of private health care is going up day by day . Take example of Fortis - Rs 16 lakhs for 15 days of treatment .
There is no guarantee that future costs will not increase .
3. We require either sufficient funds ear-marked for our medical contingencies or insurance to cover our family .
4. The Mediclaim policy we had taken 5 years ago for a"' LARGE " amount may or may not become sufficient now and may become very small part of expenses in future . Hence we may need our own additional funds for meeting expenses .
5. We may not have choice to select hospitals in emergencies as the patient has to be immediately rushed to a nearby hospital . Costs may be prohibitive there .
6 . Many hospitals do not share the cost aspect of treatment .
7 . At the end we may have to face a not so affordable large bill .
While paying for medical emergencies from our own funds or borrowed funds may cripple our finances , buying a health / mediclaim policy may be more prudent . With tax rebate under section 80d of Income Tax act , it becomes more attractive . However before buying insurance , we need to assess our own family status , our income and affordability of paying premium by us . For full guide how to buy insurance cover , visit TIPS FOR BUYING MEDICAL INSURANCE at the end of the page below .
Dated 22.11.2017 : Newspapers / media reported that a girl named Ms Adya who was admitted to Fortis Hospital - Gurugram by her father Mr Jayant Singh recently for complications from dengue fever was billed by the hospital for more than Rs 16 lakhs for a treatment given for 15 days in ICU of the hospital . It is also reported that girl didn't survive in spite of costly medical treatment she got . Though the father had insurance for Rs 10 lakhs , he has to make arrangement for additional payment for the bill . It is reported that Haryana government will investigate the matter with regard to allegations of excess charges . The hospital authorities maintained that the entire treatment and billing was as per protocol .
As the news spread in the media , the eyes of media and public opened up on the prohibitive cost of private health care in India . We could hear debate ranging over various matters related to health care system in India . We analysed that major concerns raised were with following aspects of the health care .
1. Quality of public sector hospitals
2. Cost of private sector hospitals and a need to regulate them .
3. Ethics of corporate hospitals run on commercial mode and of doctors .
4. Role of governments in controlling hospitals
5. Regulations like KPME Act , though which Karnataka government is trying to regulate private hospitals .
The above aspects are very relevant these days and require deep debates and action by governments , doctors and hospitals . Collective action by governments , medical associations , hospitals and doctors may help the common man getting medical attention in a cost effective way . However ,as for as we are concerned , we individually have to take appropriate steps to safeguard ourselves against unforeseen medical calamity that may happen and the result of the same on our lives including financial disaster . While medical calamity make us lose our beloved ones , financial mess that may create may ruin the lives of living members of the family . We may take precautions in our daily life to save ourselves from health problems by changing our life style . But we may have to fight against accidents and unexpected diseases . Further we may have to ensure ourselves financially secure for any need in such situations . Some of the points below may be worth noting :
1. We are more and more dependent on private hospitals and doctors these days .
2. The cost of private health care is going up day by day . Take example of Fortis - Rs 16 lakhs for 15 days of treatment .
There is no guarantee that future costs will not increase .
3. We require either sufficient funds ear-marked for our medical contingencies or insurance to cover our family .
4. The Mediclaim policy we had taken 5 years ago for a"' LARGE " amount may or may not become sufficient now and may become very small part of expenses in future . Hence we may need our own additional funds for meeting expenses .
5. We may not have choice to select hospitals in emergencies as the patient has to be immediately rushed to a nearby hospital . Costs may be prohibitive there .
6 . Many hospitals do not share the cost aspect of treatment .
7 . At the end we may have to face a not so affordable large bill .
While paying for medical emergencies from our own funds or borrowed funds may cripple our finances , buying a health / mediclaim policy may be more prudent . With tax rebate under section 80d of Income Tax act , it becomes more attractive . However before buying insurance , we need to assess our own family status , our income and affordability of paying premium by us . For full guide how to buy insurance cover , visit TIPS FOR BUYING MEDICAL INSURANCE at the end of the page below .
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SECURING HEALTH FOR SENIOR CITIZENS
WITH OR WITHOUT ENTRY AGE RESTRICTION
TO READ THE ARTICLE CLICK HERE
TO GET ANSWERS FOR FAQs on MANAGEMENT OF POLICIES , CLICK HERE
SECURING HEALTH FOR SENIOR CITIZENS
WITH OR WITHOUT ENTRY AGE RESTRICTION
TO READ THE ARTICLE CLICK HERE
TO GET ANSWERS FOR FAQs on MANAGEMENT OF POLICIES , CLICK HERE
From a recent report of Sample Survey Office , it is revealed that 80 percent of Indians , who mainly rely up on private health care , do not have any medical insurance . The government has brought only about 12 % of population under health protection schemes like Rashtriya Swasthya Bima Yojana . In the absence of health insurance , 75 % of Indians use their hard earned savings while 18% have to borrow . In order to escape from financial gloom in the events of medical emergencies , one has to definitely require some form of Health insurance .
PLAN YOUR HEALTH INSURANCE PRUDENTLY
MEDICAL INSURANCE - Basics
An Medical Insurance Policy would normally cover expenses incurred under the following heads in respect of each insured person subject to overall ceiling of sum insured
a. Room, Boarding expenses
b. Nursing expenses
c. Fees of surgeon, anesthetist, physician, consultants, specialists
d. Anesthesia, blood, oxygen, operation theatre charges, surgical appliances, medicines, drugs, diagnostic materials, X-ray, Dialysis, chemotherapy, Radio therapy, cost of pace maker, Artificial limbs, cost or organs and similar expenses.
Sum Insured
The Sum Insured may have a maximum amount for each of the insured under the policy or cumulative for all the insured or a fixed amount to be paid out on particular type of disease or surgery needed or affixed amount per day for the period of hospitalization.
Pre and post hospitalization expenses
Expenses incurred during a certain number of days prior to hospitalization and post hospitalization expenses for a specified period from the date of discharge may be considered as part of the claim provided the expenses relate to the disease / sickness.
Cashless Facility
Insurance companies have tie-up arrangements with a network of hospitals in the country. If policyholder takes treatment in any of the net work hospitals, there is no need for the insured person to pay hospital bills. The Insurance Company, through its Third Party Administrator (TPA) will arrange direct payment to the Hospital. Expenses beyond sub limits prescribed by the policy or items not covered under the policy have to be settled by the insured direct to the Hospital. The insured can take treatment in a non-listed hospital in which case he has to pay the bills first and then seek reimbursement from Insurance Co. There will be no cashless facility applicable here.
An Medical Insurance Policy would normally cover expenses incurred under the following heads in respect of each insured person subject to overall ceiling of sum insured
a. Room, Boarding expenses
b. Nursing expenses
c. Fees of surgeon, anesthetist, physician, consultants, specialists
d. Anesthesia, blood, oxygen, operation theatre charges, surgical appliances, medicines, drugs, diagnostic materials, X-ray, Dialysis, chemotherapy, Radio therapy, cost of pace maker, Artificial limbs, cost or organs and similar expenses.
Sum Insured
The Sum Insured may have a maximum amount for each of the insured under the policy or cumulative for all the insured or a fixed amount to be paid out on particular type of disease or surgery needed or affixed amount per day for the period of hospitalization.
Pre and post hospitalization expenses
Expenses incurred during a certain number of days prior to hospitalization and post hospitalization expenses for a specified period from the date of discharge may be considered as part of the claim provided the expenses relate to the disease / sickness.
Cashless Facility
Insurance companies have tie-up arrangements with a network of hospitals in the country. If policyholder takes treatment in any of the net work hospitals, there is no need for the insured person to pay hospital bills. The Insurance Company, through its Third Party Administrator (TPA) will arrange direct payment to the Hospital. Expenses beyond sub limits prescribed by the policy or items not covered under the policy have to be settled by the insured direct to the Hospital. The insured can take treatment in a non-listed hospital in which case he has to pay the bills first and then seek reimbursement from Insurance Co. There will be no cashless facility applicable here.
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Additional Benefits and other Riders
Insurance companies offer various other benefits like “ Health Checkup “. There are also policies that give benefits like “Hospital Cash”, “Critical Illness Benefits”, “Surgical Expense Benefits” etc. These policies can either be taken separately or in addition to the hospitalization policy. A few companies have come out with products in the nature of Top Up policies to meet the actual expenses over and above the limit available in the basic health policy.
Exclusions
The following are generally excluded under Mediclaim policies:
a. All pre-existing diseases
b. Under first year policy, any claim during the first 30 days from date of cover, for sickness / disease. This is not applicable for accidental injury claims.
c. During first year of cover – cataract, Benign prosthetic hypertrophy, Hysterectomy for Menorrhagia or Fibromyoma, Hernia, Hydrocele, Congenital Internal diseases, Fistula in anus, piles, sinusitis and related disorders.
d. Circumcision unless for treatment of a disease
e. Cost of specs, contact lenses, hearing aids
f. Dental treatment / surgery unless requiring hospitalization
g. Convalescence, general debility, congenital external defects, V.D., intentional self-injury, use of intoxicating drugs / alcohol, AIDS, Expenses for Diagnosis, X-ray or lab tests not consistent with the disease requiring hospitalization.
h. Treatment relating to pregnancy or child birth including cesarean section
i. Naturopathy treatment.
The actual exclusions may vary
FLOATER POLICIES
Family Floater is one single policy that takes care of the hospitalization expenses of entire family. The policy has one single sum insured, which can be utilized by any/all insured persons in any proportion or amount subject to maximum of overall limit of the policy sum insured. Quite. Family floater plans are better than buying separate individual policies all
TAX BENEFIT UNDER SECTION 80D OF INCOME TAX ACT
Deduction allowed on Medicliam Policies under 80 D is Rs. 50,000/- for senior citizens and up to Rs. 25,000/- for others from the financial year 2018-19 . For senior citizens , if no insurance amount is paid , hospital expenditure up to Rs 50,000 is allowed . An assessee can claim additional Rs 50,000 for his / her parents if they are senior citizens and Rs 25,000 in other cases . Overall claim cannot exceed Rs 1,00,000 . All payments should have been made in any mode other than cash . Cost of preventive health check up up to Rs 5,000 can be claimed within the overall limit and it could have been made in cash also .
Insurance companies offer various other benefits like “ Health Checkup “. There are also policies that give benefits like “Hospital Cash”, “Critical Illness Benefits”, “Surgical Expense Benefits” etc. These policies can either be taken separately or in addition to the hospitalization policy. A few companies have come out with products in the nature of Top Up policies to meet the actual expenses over and above the limit available in the basic health policy.
Exclusions
The following are generally excluded under Mediclaim policies:
a. All pre-existing diseases
b. Under first year policy, any claim during the first 30 days from date of cover, for sickness / disease. This is not applicable for accidental injury claims.
c. During first year of cover – cataract, Benign prosthetic hypertrophy, Hysterectomy for Menorrhagia or Fibromyoma, Hernia, Hydrocele, Congenital Internal diseases, Fistula in anus, piles, sinusitis and related disorders.
d. Circumcision unless for treatment of a disease
e. Cost of specs, contact lenses, hearing aids
f. Dental treatment / surgery unless requiring hospitalization
g. Convalescence, general debility, congenital external defects, V.D., intentional self-injury, use of intoxicating drugs / alcohol, AIDS, Expenses for Diagnosis, X-ray or lab tests not consistent with the disease requiring hospitalization.
h. Treatment relating to pregnancy or child birth including cesarean section
i. Naturopathy treatment.
The actual exclusions may vary
FLOATER POLICIES
Family Floater is one single policy that takes care of the hospitalization expenses of entire family. The policy has one single sum insured, which can be utilized by any/all insured persons in any proportion or amount subject to maximum of overall limit of the policy sum insured. Quite. Family floater plans are better than buying separate individual policies all
TAX BENEFIT UNDER SECTION 80D OF INCOME TAX ACT
Deduction allowed on Medicliam Policies under 80 D is Rs. 50,000/- for senior citizens and up to Rs. 25,000/- for others from the financial year 2018-19 . For senior citizens , if no insurance amount is paid , hospital expenditure up to Rs 50,000 is allowed . An assessee can claim additional Rs 50,000 for his / her parents if they are senior citizens and Rs 25,000 in other cases . Overall claim cannot exceed Rs 1,00,000 . All payments should have been made in any mode other than cash . Cost of preventive health check up up to Rs 5,000 can be claimed within the overall limit and it could have been made in cash also .
ISSUERS OF HEALTH COVERS
Mediclaim policies are issued by specialized Health / Medical Insurance companies , Life Insurers as well as General Insurers .
To get the list and visit their websites , Click Here
Mediclaim policies are issued by specialized Health / Medical Insurance companies , Life Insurers as well as General Insurers .
To get the list and visit their websites , Click Here
TIPS FOR BUYING MEDICLAIM POLICIES
1. Various Insurance companies offer health / mediclaim Policies . But the terms , diseases covered and premiums vary . Hence first write down your needs like whether you have parents & children to be covered , Medical history of your family members , and the amount of coverage you require . Please remember the medical costs are increasing year after year and what looks like suffice today may not cover fraction of your requirement after 5 years . Hence keep cushion while having the amount fixed .
2. You check the hospitals in your city , especially which are convenient to you , are covered under cashless facility by TPA .
3. Compare the premiums from three or four insurance companies for the least . and you can find huge variation from company to company and chose the one which suits your budget and requirements .
4. Floaters policies covering all the members of your family are cheaper than taking individual policies and hence get a policy which can cover your family members .
5. Check whether premiums are kept at the same level as offered for at least for few years . Otherwise every year you will have to pay higher demanded premiums .
6. Check up to what your age the policy will cover . There are policies which cover up o maximum age of 80 years . Otherwise at the ripe age when you require insurance , umbrella of insurance would be removed .
7. Check towards the conditions on pre-existing diseases . Lesser period will be better .
8. If you have already covered by a Mediclaim policy taken by yourself or your employer and if you feel the amount covered is not sufficient , you may go in for a Top up Health Insurance or Super top up health insurance which will cover you beyond the amount covered by your initial policy .
9. Health policies get income tax rebates under SEC 80D . For details , CLICK HERE
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VIDEO ON " HOW TO BUY A MEDICAL POLICY IN INDIA "
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