6 health insurance claim rule changes you should know: Report

Jun 26, 2024 07:58 PM IST

India’s health insurance has seen multiple changes in recent times, with the Insurance Regulatory and Development Authority of India (IRDAI) overhauling multiple rules on health insurance claims, according to an Economic Times report.

What are the new health insurance claim rules?

1) Cashless health insurance claims anywhere

You need not pay the hospital, even if it is a non-network kind, and can claim the medical fees from the insurer immediately, while earlier, you had to pay out of your pocket and then, claim for a reimbursement after being discharged.

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2) Cashless claim clearance time

Insurers have to clear claims within three hours of receiving it from the hospital during discharge and have one hour to clear cashless claims at the time of admission, cutting down delays.

3) Waiting period cut for pre-existing diseases

Earlier, if you had a specific health condition or disease at the time of buying your health insurance policy, you had to wait for 4 years to become eligible to claim insurance for that condition. This waiting period has now been reduced to 3 years.

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4) No limitation for Ayush treatment

Ayush treatments including ayurveda, yoga, unani, siddha, and homoeopathy are now recognised by the Insurance regulator (IRDAI) and claims won’t be rejected for Ayush treatment if you fulfill the specified conditions.

5) Moratorium period cut to 5 years

If you have a health plan with continuous coverage for five years, which includes portability and migration, the insurer cannot contest any claim on grounds of non-disclosure or misrepresentation, except in cases of fraud. This period was eight years earlier.

6) Claims with multiple insurers

You can make a claim for a single hospitalisation from multiple health insurance policies. For example, if you have two policies worth Rs.5 lakh and Rs.10 lakh, and you get a hospital bill of Rs.12 lakh, both the policies can be used to settle the claim.

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