New health insurance rules from October 1: Telemedicine coverage, no rejection after 8 years and more

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Aiming to make the health insurance plans more consumer-friendly and cover more treatments, the Insurance Regulatory and Development Authority of India (IRDAI) issued new guidelines for the medical insurance companies which will come into effect from today (October 1) onwards.   

The move by the IRDAI holds significance as the new guidelines come at a time when the country is grappling with the coronavirus crisis and the GDP has contracted to a 40-year low. The new guidelines, issued in June by IRDAI, will apply to all general and health insurance companies. These changes are expected to benefit the policyholders. Let’s understand what are these changes and how will it impact you.

No Rejection After 8 Years

As per the new guidelines, the insurance provider can not reject a claim of a policyholder who has paid a premium for eight years continuously unless except for proven fraud and permanent exclusions. Insurers will also be not permitted to re-evaluate a policy for which the customer has paid.

Decision On A Claim Within 30 Days

The new rules also mandate that insurance providers must either settle or reject a claim within 30 days from the date of its receipt, under certain conditions.

Interest in case of Delay

Any Delay Means Interest In case, the insurance provider fails to decide on the claim within 30 days, it will be required to pay interest at a rate of 2 per cent above the applicable bank rate on the dues to the policyholder.

Coverage for telemedicine

As telemedicine became popular in the post-COVID world, IRDAI asked insurers to cover the medical costs incurred on telemedicine if their health plans offered coverage for doctor’s consultations. So, now, health plans have become all the more inclusive as they cover telemedicine costs too

New Definition of Pre-existing Disease

Any disease or ailment that is diagnosed by a physician 48 months prior to the issuance of the health cover will be classified as pre-existing diseases. Besides, any condition whose symptoms have resulted within three months of the policy issuance will also be classified under pre-existing diseases. Treatment for mental illness, stress will now be covered under health insurance policies.

No reduction in the coverage ratio

There will be no reduction in ratio. Pharmacy, implant and diagnostic will not be associated as medical expenses, which means you will get a full claim for the same.

Source: MSN