KNOW THE NEW GUIDELINES ON YOUR MEDICAL INSURANCE |
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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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LATEST IRDAI GUIDELINES ON HEALTH INSURANCE
HEALTH POLICIES SHOULD COVER NEW-BORNS AND ALSO MENTAL HEALTH
Dated 20.10.20222 : It has come to attention of IRDAI that some insurance companies are not covering new-born children of the policy holders from day-1 and some are excluding treatment of mental illness from the cover of their health policies .
As per IRDAI 's master circular of July 2022 , the internal congenital diseases, genetic diseases or disorders are not allowed to be incorporated as exclusions in the terms and conditions of the policy contract. Hence health policies have to invariably cover newborns with internal congenital birth defects from day one .
In 2021 itself , IRDAI had asked insurance companies to comply with the provisions of the Mental Health Care Act, 2017 (MHC Act-2017) with immediate effect and to provide cover for mental health in all their health policies .
Now once again IRDAI has reiterated to insurance companies to comply with their earlier instructions .
To read IRDAI Circular dated 18.10.2022 on new-born , CLICK HERE
To read IRDAI Circular dated 18.10.2022 on mental illness , CLICK HERE
Dated 20.10.20222 : It has come to attention of IRDAI that some insurance companies are not covering new-born children of the policy holders from day-1 and some are excluding treatment of mental illness from the cover of their health policies .
As per IRDAI 's master circular of July 2022 , the internal congenital diseases, genetic diseases or disorders are not allowed to be incorporated as exclusions in the terms and conditions of the policy contract. Hence health policies have to invariably cover newborns with internal congenital birth defects from day one .
In 2021 itself , IRDAI had asked insurance companies to comply with the provisions of the Mental Health Care Act, 2017 (MHC Act-2017) with immediate effect and to provide cover for mental health in all their health policies .
Now once again IRDAI has reiterated to insurance companies to comply with their earlier instructions .
To read IRDAI Circular dated 18.10.2022 on new-born , CLICK HERE
To read IRDAI Circular dated 18.10.2022 on mental illness , CLICK HERE
Draft guidelines on Group Health Insurance by IRDAI :
29.04 2022 : IRDAI has come out with a draft for fresh set of Guidelines to be issued to Insurance companies in the matter og Group Health insurance for protecting the interests of insuring public . For the detailed guidelines , you may please visit our webpage " GROUP HEALTH INSURANCE " . You may also forward your comments/suggestions to IRDAI before 13th May 2022 .
29.04 2022 : IRDAI has come out with a draft for fresh set of Guidelines to be issued to Insurance companies in the matter og Group Health insurance for protecting the interests of insuring public . For the detailed guidelines , you may please visit our webpage " GROUP HEALTH INSURANCE " . You may also forward your comments/suggestions to IRDAI before 13th May 2022 .
IRDAI CAUTIONS PUBLIC ON EVEN HEALTHCARE PVT LTD , BENGALURU
15.04.2022 : Press Release dated 13.04.2022 of Insurance Regulatory and Development Authority of India ( IRDAI ) advises general public
that IRDAI has noticed an entity by the name “Even Healthcare Pvt Ltd” having their corporate office at ‘No.311,6th Main Road, HAL 2nd Stage, Indira nagar, Bengaluru, Karnataka- 560038’ and having website www.even.in is offering health plans. Further IRDAI informs the public that the plans offered by Even Health are not health insurance plans and the said entity is not a registered entity with IRDAI.
Public subscribing to these plans of “Even Healthcare Pvt Ltd” are advised by IRDAI that they are dealing at their own risk. It is clarified that only IRDAI registered insurance companies or their appointed insurance agents and insurance intermediaries can sell insurance products. Public are advised by IRDAI to exercise caution while dealing with unregulated entities and to avail health insurance products and services from IRDAI registered insurance companies. The list of insurance companies registered with IRDAI may be accessed at https://www.irdai.gov.in/ADMINCMS/cms/NormalData_Layout.aspx?page=PageNo264&mid=3.2.10
For IRDAI Press Release . CLICK HERE
15.04.2022 : Press Release dated 13.04.2022 of Insurance Regulatory and Development Authority of India ( IRDAI ) advises general public
that IRDAI has noticed an entity by the name “Even Healthcare Pvt Ltd” having their corporate office at ‘No.311,6th Main Road, HAL 2nd Stage, Indira nagar, Bengaluru, Karnataka- 560038’ and having website www.even.in is offering health plans. Further IRDAI informs the public that the plans offered by Even Health are not health insurance plans and the said entity is not a registered entity with IRDAI.
Public subscribing to these plans of “Even Healthcare Pvt Ltd” are advised by IRDAI that they are dealing at their own risk. It is clarified that only IRDAI registered insurance companies or their appointed insurance agents and insurance intermediaries can sell insurance products. Public are advised by IRDAI to exercise caution while dealing with unregulated entities and to avail health insurance products and services from IRDAI registered insurance companies. The list of insurance companies registered with IRDAI may be accessed at https://www.irdai.gov.in/ADMINCMS/cms/NormalData_Layout.aspx?page=PageNo264&mid=3.2.10
For IRDAI Press Release . CLICK HERE
HEALTH INSURANCE POLICIES COVER OMICRON ALSO :
Dated 05.01.2022 : In view of raising number of cases of omicron virus , Insurance Regulatory & Development Authority of India ( IRDAI ) has come out with a clarification that all health insurance products that cover the treatment costs of hospitalization offered by all general and health insurance companies also cover the costs of hospitalization treatment on account of Covid -19 including omicron variant of the virus .
Further IRDAI has asked the insurance companies suitably inform their network partners ( like TPA & Hospitals ) . IRDAI has also requested to honour the service level agreements (SLA) that have been entered with insurance companies for the purpose of providing cashless treatment to health insurance policyholders.
Thus health insurance policies now cover all hospitalization on account of covid 19 variants as well as vaccine related hospitalization .
For IRDAI Press Release , CLICK HERE
Dated 05.01.2022 : In view of raising number of cases of omicron virus , Insurance Regulatory & Development Authority of India ( IRDAI ) has come out with a clarification that all health insurance products that cover the treatment costs of hospitalization offered by all general and health insurance companies also cover the costs of hospitalization treatment on account of Covid -19 including omicron variant of the virus .
Further IRDAI has asked the insurance companies suitably inform their network partners ( like TPA & Hospitals ) . IRDAI has also requested to honour the service level agreements (SLA) that have been entered with insurance companies for the purpose of providing cashless treatment to health insurance policyholders.
Thus health insurance policies now cover all hospitalization on account of covid 19 variants as well as vaccine related hospitalization .
For IRDAI Press Release , CLICK HERE
AUTHORISE CASHLESS FACILITY IN 60 MINUTES : IRDAI
Dated 30 .04.2021 : Following the order of Honoroubale High court of Delhi , , Insurance Regulatory & Development Authority of India ( IRDAI ) has instructed the insurers & TPAs to dispose any request of hospitals for cashless treatment of codid-19 patients under a health insurance policy within 60 minutes of receipt of request .
Further they are also advised insurance companies to dispose of final bills from the hospital at the time of discharge within 60 minutes of receipt of the bill again .
IRDAI has also issued detailed guidelines to insurers , TPAs and hospitals , vide their earlier circular dated 23.04.2021 , with regard to cashless facility to be extended for covid-19 patients under any health insurance policy .
To read IRDAI Instructions , click here
Dated 30 .04.2021 : Following the order of Honoroubale High court of Delhi , , Insurance Regulatory & Development Authority of India ( IRDAI ) has instructed the insurers & TPAs to dispose any request of hospitals for cashless treatment of codid-19 patients under a health insurance policy within 60 minutes of receipt of request .
Further they are also advised insurance companies to dispose of final bills from the hospital at the time of discharge within 60 minutes of receipt of the bill again .
IRDAI has also issued detailed guidelines to insurers , TPAs and hospitals , vide their earlier circular dated 23.04.2021 , with regard to cashless facility to be extended for covid-19 patients under any health insurance policy .
To read IRDAI Instructions , click here
CASHLESS FACILITY FOR COVID HOSPITALIZATION :
Dated 23.04.2021 : In view of complaints with regard to refusal of cashless facility and overcharging in cash settlements by some hospitals , Insurance Regulatory & Development Authority of India ( IRDAI ) has come out with following guidelines / instructions for the insurers , TPAs and hospitals .
For insurers :
1. There are reports of certain network providers (hospitals) charging high rates and insisting on cash payments from the policyholders for providing treatment to COVID-19 infected patients despite having cashless arrangement with Insurers.
2. In compliance with the provisions of Regulation 31of IRDAI ( Health Insurance ) Regulations, 2016, the Insurers, in case of “cashless claim” under a health insurance policy, are advised to ensure expeditious settlement of such claims on cashless basis in accordance to the Service Level Agreements ( SLAs) entered with hospitals.
3. While reviewing cashless requests the Insurers are also advised to ensure that the policyholders are charged as per the rates agreed to by network providers wherever applicable. Insurers are also advised to ensure that hospitals do not levy any additional charges for the same treatment other than those rates that are agreed with the insurers.
4. In order to ensure that all network providers extend cashless services to policyholders and to address any issues causing inconvenience to policyholders while availing cashless service, the Insurers are advised to put in place an effective communication channel with all the network providers for prompt resolution of grievances of policyholders. Insurers are advised to report levying of excess charges or denial of cashless facility to the respective State Governments for appropriate action.
For Hospitals : All hospitals are also requested not to differentiate the patients in terms of admission or treatment whether they are insured or not insured or whether they pay cash or avail of cashless facility. A gesture of this nature on the part of hospitals in these difficult times will
re-inforce the confidence of the public in the healthcare system including health insurance and build trust.
To read circular for insurers , CLICK HERE / For press release , CLICK HERE
Dated 23.04.2021 : In view of complaints with regard to refusal of cashless facility and overcharging in cash settlements by some hospitals , Insurance Regulatory & Development Authority of India ( IRDAI ) has come out with following guidelines / instructions for the insurers , TPAs and hospitals .
For insurers :
1. There are reports of certain network providers (hospitals) charging high rates and insisting on cash payments from the policyholders for providing treatment to COVID-19 infected patients despite having cashless arrangement with Insurers.
2. In compliance with the provisions of Regulation 31of IRDAI ( Health Insurance ) Regulations, 2016, the Insurers, in case of “cashless claim” under a health insurance policy, are advised to ensure expeditious settlement of such claims on cashless basis in accordance to the Service Level Agreements ( SLAs) entered with hospitals.
3. While reviewing cashless requests the Insurers are also advised to ensure that the policyholders are charged as per the rates agreed to by network providers wherever applicable. Insurers are also advised to ensure that hospitals do not levy any additional charges for the same treatment other than those rates that are agreed with the insurers.
4. In order to ensure that all network providers extend cashless services to policyholders and to address any issues causing inconvenience to policyholders while availing cashless service, the Insurers are advised to put in place an effective communication channel with all the network providers for prompt resolution of grievances of policyholders. Insurers are advised to report levying of excess charges or denial of cashless facility to the respective State Governments for appropriate action.
For Hospitals : All hospitals are also requested not to differentiate the patients in terms of admission or treatment whether they are insured or not insured or whether they pay cash or avail of cashless facility. A gesture of this nature on the part of hospitals in these difficult times will
re-inforce the confidence of the public in the healthcare system including health insurance and build trust.
To read circular for insurers , CLICK HERE / For press release , CLICK HERE
VACCINE RELATED HOSPITALIZATION ALSO COVERED : IRDAI
Dated 19.03.2021 : It appears that there's vaccine hesitancy on the part of some and are reluctant to have covid vaccine due to fear of adverse effects and medical complications on their regular health by taking he vaccine . The covid vaccine is available free of cost at government centres and for a fee of Rs 250 at the private hospitals for the senior citizens and others aged above 45 with comorbidities .
In order to dispel fear of the financial burden due to unlikely event of hospitalization after the jab , IRDAI has clarified that such hospitalizations will also be covered in the regular health policies already taken as per the terms and conditions of the policy .
To read the press release of IRDAI dated 18.03.2021 , CLICK HERE
Dated 19.03.2021 : It appears that there's vaccine hesitancy on the part of some and are reluctant to have covid vaccine due to fear of adverse effects and medical complications on their regular health by taking he vaccine . The covid vaccine is available free of cost at government centres and for a fee of Rs 250 at the private hospitals for the senior citizens and others aged above 45 with comorbidities .
In order to dispel fear of the financial burden due to unlikely event of hospitalization after the jab , IRDAI has clarified that such hospitalizations will also be covered in the regular health policies already taken as per the terms and conditions of the policy .
To read the press release of IRDAI dated 18.03.2021 , CLICK HERE
READ OUR ARTICLES ON TOPICS IN HEALTH INSURANCE
NEW ARTICLE ON GROUP HEALTH INSURANCE PLANS
COVID INSURANCE FLOATER POLICIES
SENIOR CITIZENS INSURANCE MASHAK RAKSHAK PLAN
LATEST AROGYA SANJEEVANI PLAN HOSPITAL CASH PLANS
NEW ARTICLE ON GROUP HEALTH INSURANCE PLANS
COVID INSURANCE FLOATER POLICIES
SENIOR CITIZENS INSURANCE MASHAK RAKSHAK PLAN
LATEST AROGYA SANJEEVANI PLAN HOSPITAL CASH PLANS
POLICY DETAILS TO BE COMMUNICATED EVERY SIX MONTHS : IRDAI
Dated 02.03.2021 : As per latest IRDAI Guidelines , all General insurers and health insurance companies have to furnish following health policy details to their policy holders every six months :
a. Name of Product and policy number,
b. Extent of coverage available by way of available Sum Insured and Cumulative Bonus,
c. Number of insured people covered under policy,
d. Policy period,
e. Number and amount of claim settled (under relevant period), if any,
f. Balance Sum Insured and Accrued cumulative bonus available, if any,
g. Due date of renewal and premium payment frequency,
h. Premium amount due on renewal (to be specified at the time of renewal)
i. Grace Period (within 5 days after renewal due date)
j. Contact details (for any query or other issues) of customer support service of Insurer, Toll Free No. or e-mail Id etc.
Dated 02.03.2021 : As per latest IRDAI Guidelines , all General insurers and health insurance companies have to furnish following health policy details to their policy holders every six months :
a. Name of Product and policy number,
b. Extent of coverage available by way of available Sum Insured and Cumulative Bonus,
c. Number of insured people covered under policy,
d. Policy period,
e. Number and amount of claim settled (under relevant period), if any,
f. Balance Sum Insured and Accrued cumulative bonus available, if any,
g. Due date of renewal and premium payment frequency,
h. Premium amount due on renewal (to be specified at the time of renewal)
i. Grace Period (within 5 days after renewal due date)
j. Contact details (for any query or other issues) of customer support service of Insurer, Toll Free No. or e-mail Id etc.
IRDAI COMES OUT WITH NEW MASHAK RAKSHAK POLICY COVERING VECTOR BORNE DISEASES
Dated 05.02.2021 : IRDAI has come out with a new standard plan that covers vector borne diseases like Dengue Fever , Malaria etc . Thepolicy is called Mashak Rakshak Policy and comes under micro insurance category .Policies will be issued by General insurance companies and health insurance companies . For complete details of the plan , CLICK HERE
Dated 05.02.2021 : IRDAI has come out with a new standard plan that covers vector borne diseases like Dengue Fever , Malaria etc . Thepolicy is called Mashak Rakshak Policy and comes under micro insurance category .Policies will be issued by General insurance companies and health insurance companies . For complete details of the plan , CLICK HERE
PORTABILITY OF HEALTH INSURANCE POLICIES
PORTABILITY / MIGRATION OF HEALTH INSURANCE POLICIES :
DATED 08.10.2020 : Are you unhappy with your health insurer ? Whether your insurer is delaying claim reimbursement ? Is your nearby hospital does not offer cashless facility for the particular TPA your policy assigns ? Do you want to change the plan from single to family floater ?
Now from 1st, October 2020 , all new policies issued have to come with portability and migration clause clause as per IRDAI Guidelines .
Now you 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 you are presently covered and have been continuously covered without any lapses under any health insurance product/plan offered by the company, you will get the accrued continuity benefits in waiting periods .
Further you 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 you are presently covered and have been continuously covered without any lapses under any health insurance policy with an Indian General/Health insurer, you will get the accrued continuity benefits in waiting periods .
Further If you have taken group health insurance policy offered to account holders of a bank , you are allowed portability of the coverage to another indemnity based group health insurance policy offered by a different insurer to the account holders of the same bank. ( As per the latest IRDAI Guidelines dated 07.10.2020 )
DATED 08.10.2020 : Are you unhappy with your health insurer ? Whether your insurer is delaying claim reimbursement ? Is your nearby hospital does not offer cashless facility for the particular TPA your policy assigns ? Do you want to change the plan from single to family floater ?
Now from 1st, October 2020 , all new policies issued have to come with portability and migration clause clause as per IRDAI Guidelines .
Now you 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 you are presently covered and have been continuously covered without any lapses under any health insurance product/plan offered by the company, you will get the accrued continuity benefits in waiting periods .
Further you 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 you are presently covered and have been continuously covered without any lapses under any health insurance policy with an Indian General/Health insurer, you will get the accrued continuity benefits in waiting periods .
Further If you have taken group health insurance policy offered to account holders of a bank , you are allowed portability of the coverage to another indemnity based group health insurance policy offered by a different insurer to the account holders of the same bank. ( As per the latest IRDAI Guidelines dated 07.10.2020 )
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
HEALTH INSURANCE POLICIES TO BE ISSUED STANDARDIZED TERMS & CONDITIONS ONLY FROM 01.10 .2020
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.
PRE-EXISTING DISEASES (not applicable for Overseas Travel Insurance )
Pre-existing Disease means any condition, ailment, injury or disease:
a) That is/are diagnosed by a physician within 48 months prior to the effective date of the policy issued by the insurer or its reinstatement or
b) For which medical advice or treatment was recommended by, or received from, a physician within 48 months prior to the effective date of the policy issued by the insurer or its reinstatement.
(Life Insurers may define norms for applicability of PED at reinstatement).
(Note: All existing health insurance products that are not in compliance with this definition shall not be offered and promoted from 01st October, 2020 onwards)
Other Provisions:
Where these general terms and clauses are used, 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 & HERE
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.
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 .
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 .
NEW ARTICLE
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 .
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FOR INCOME TAX NEWS , CLICK HERE NEWS ON INTEREST RATES CLICK HERE
ARTICLE ON INVESTMENT OPTIONS FOR RETIREES , CLICK HERE WHAT IS SYSTEMATIC INVESTMENT PLAN ? CLICK HERE
NEW ARTICLES ON
SMALL FINANCE BANKS PAYMENT BANKS
UNIFIED PAYMENT INTERFACE BHARAT BILL PAYMENT SYSTEM
BHIM APP AADHAR
e-INSURANCE Account ( eIA )
WHAT IS NEW ON PLAN N PROGRESS ?
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
