IRDA to Standardize Guidelines and Rules to Health and Mediclaim Insurance

The health insurance sector has witnessed steep growth during the past few years in India. This has largely been contributed by the fact that people now understand the importance of health care and health insurance as a medical treatment has gone expensive over the years. Another factor leading to the growth of this factor is an increase in disposable income of the people.

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      The main aim of the health insurance industry is not to sell and market health insurance policies but also provide timely and efficient claims during their requirement. Health insurance policyholders often complain about claims being denied by the insurance company on perky grounds. This has resulted in regulatory authority to develop new standardized procedures to help people to make successful claims.

      New Rules to Standardize Health Insurance Sector by IRDA

      The insurance sector is regulated by the Insurance Regulatory Development Authority (IRDA) of India in our country and the organization has introduced several new rules to standardize this sector aiming to increase the convenience of insurance holders.

      In order to avoid misunderstandings and ambiguity of the insurance policies, the regulatory body has defined guidelines to standardize health insurance practices in the country. It has laid some rules which are required to be used as a mandatory clause in the documentation of each and every health insurance policy.

      Some of the guidelines framed by IRDA insurance include critical illness, pre-existing diseases, hospitalization etc. The regulatory body has defined these terms and health insurance companies are required to be used the same words while framing policy wordings for each and every policy. the body has defined pre-existing disease as “Any condition, ailment or injury or related condition(s) for which you had signs or symptoms, and / or were diagnosed, and / or received medical advice / treatment within 48 months to prior to the first policy issued by the insurer” and hospitalization as “A minimum stay for 24 hours in the hospital”. Further, the hospital has been defined as more clearly as “A hospital should have at least 10 inpatient beds, in those towns having a population of less than 10, 00,000 and 15 inpatient beds in all other places”.

      You may also like to Read: 80D Income Tax Deduction

      These new guidelines laid down by the IRDA insurance regulatory body aims to decrease the frauds and to increase satisfaction among insurance policyholders. The other main reason for laying these rules is to increase the trust between insured and insurer in order to facilitate the development of this sector. With these simplified rules, insurance seekers will be able to understand different clauses of the policy and will help them to buy suitable policy meeting their needs.

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      Disclaimer: The list mentioned is according to the alphabetical order of the insurance companies. Policybazaar does not endorse, rate or recommend any particular insurer or insurance product offered by any insurer. For complete list of insurers in India refer to the Insurance Regulatory and Development Authority of India website www.irdai.gov.in

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      *We will respond in the first instance within 30 minutes of the customers contacting us. 30-minute claim support service is for the purpose of giving reasonable assistance to the policyholder in pursuance of the claim. Settlement of claim (including cashless claim) is the responsibility of the insurer as per policy terms and conditions. The 30- minute claim support is subject to our operations not being impacted by a system failure or force majeure event or for reasons beyond our control. For further details, 24x7 Claims Support Helpline can be reached out at 1800-258-5881.

      *Product information is authentic and solely based on the information received from the Insurer. Policybazaar is acting only as a facilitator and claims settlement shall be at the sole discretion of the Insurer. Policybazaar does not provide any medical or surgical advice or diagnosis and is not responsible for your interactions / treatment by a medical practitioner/hospital. Please consult a registered medical practitioner for any medical or surgical advice. The Information that you obtain or receive from Policybazaar, and its employees, or otherwise on the Website is for informational purposes only. As per the Insurance guidelines, you are allowed to cancel the policy with-in 30 days from the date of Issuance of policy.This option is available incase of policies with a term of one year or more.

      *All the health insurance plans cover hospitalization expenses including COVID-19 treatment cover up to the specified limits. You can also buy specific COVID-19 health insurance policies such as Corona Kavach Policy and Corona Rakshak policy.

      **All savings and online discounts are provided by insurers as per IRDAI approved insurance plans. #Tax Benefits are subject to changes in tax laws. GST Exemptions depend on fulfilment of qualification criteria and submission of relevant documents.

      *₹1748/month is the starting price for a 1 crore health insurance for an 18-year-old male, with no pre-existing diseases. Discount on renewal premium is subject to the number of wellness points earned in the health insurance policy. For more details about the plans, please read the sale brochure carefully to get upto 100% discount on renewal premium.

      *₹400/month is the starting price for ₹ 5 lakh Health insurance for a 30 year old male & 29 years old female, living in Delhi with no pre-existing diseases

      *₹541/month is the starting price for ₹ 10 lakh Health insurance for a 30 year old male & 29 years old female, living in Delhi with no pre-existing diseases

      *₹762/month is the starting price for ₹ 1 Crore Health insurance for a 30 year old male & 29 years old female, living in Delhi with no pre-existing diseases

      *₹243/month(₹ 8/day) is the starting price for a 5 lakh health insurance for a 20-year-old male, non-smoker, living in Bengaluru with no pre-existing diseases

      *₹2020/month is the starting price for ₹ 1 Cr Health insurance for a 50 year old male & 50 years old female, living in Bangalore with no pre-existing diseases rounded off to nearest 10.

      *₹390/month (₹13 per day) is starting price for 1 cr. Health insurance for 25 years old male, with pre-existing diseases, residing from tier 1 city rounded off to the nearest 10.

      *No medical tests are required unless requested by the insurer’s underwriter. In-case of pre-existing diseases relevant medical proof would be required as per the terms and condition of the policy opted.

      *The values taken for effective cost calculation are indicative values and may change as per the selected plan.

      *Coverage upto double the amount of Sum Insured is available on certain covers for a minimum plan of Rs. 5 Lakh on the first claim only to an individual of upto 45 years of age with no pre-existing diseases. The benefit is available with or without extra cost depending on the plan chosen.

      *Coverage of pre-existing diseases is provided by insurer as per their underwriting policy.

      *The scope of coverage may vary from plan to plan.

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