Health Insurance
This article discusses the latest Master Circular on Health Insurance Business, issued on 29/05/2024, which introduced significant changes aimed at enhancing policyholder protection and streamlining claim settlements.
Once you have 60 months of continuous coverage, your claims cannot be contested for non-disclosure or misrepresentation except in fraud cases. This change provides greater security and reliability for long-term policyholders. This figure used to be 8 years earlier.
New guidelines require insurers to decide on cashless authorization within one hour, aiming for 100% cashless claim settlements. This helps reduce the financial burden on policyholders during emergencies and hospitalizations.
Related:
Frequently asked questions (FAQs) on Cashless Everywhere facility in health insurance
Policyholders can now choose between a cumulative bonus or a discount in renewal premiums, offering more flexibility and rewards for maintaining good health.
Insurers must process discharge authorizations within three hours. Any delay costs will be covered by the insurer, ensuring prompt discharge and reducing additional costs for policyholders.
The Claims Review Committee ensures that no claims are unjustly denied without a thorough review. Insurers or TPAs are responsible for collecting all required documents, making the claim process smoother for policyholders.
The Moratorium Period is a 60-month duration of continuous coverage after which no health insurance policy or claim can be contested for non-disclosure or misrepresentation, except for fraud. Credits from ported and migrated policies count towards this period.
The No Claim Bonus rewards policyholders who do not make a claim. It can be given as:
Yes, policyholders can hold multiple health insurance policies. In the event of a claim, they can choose which policy to claim benefits from, and insurers must coordinate to ensure seamless settlement in case there is a need to claim from a second policy.
The direct link to this document is here
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This post titled What Policyholders Must Know about IRDA's Master Circular on Health Insurance Business (29/05/2024)? first appeared on 18 Jun 2024 at https://arthgyaan.com