Health insurance policyholders have good news as IRDAI makes new changes

The Insurance Regulatory and Development Authority of India (Irdai) has announced some policy measures to make health insurance settlements transparent and simple. The measures will come into effect from October 1.

Because of the streamlining of the concept of ‘associate medical expenses’ and restriction of ‘proportionate deduction’, the out-of-pocket expenses of the policyholders are going to come down. Health insurance policies have cost limits beyond which reimbursement won’t be available for policyholders. So, a policyholder who gets treated in a room that costs higher than the one mentioned in the health insurance policy in a hospital doesn’t get full reimbursement in the existing system. This will be different in the new system.

Cost of pharmacy, cost of medical implants and devices, and cost of diagnostics are not part of the ‘associate medical expenses’ from now.

“Mental illness, age-related degeneration, internal congenital diseases and artificial life maintenance, illnesses arising due to hazardous activities will be covered from now,” a Money Control report says. Cataract surgery and knee-cap replacements will also be included.

A policyholder’s insurance claim can’t be rejected from the 9th year of policy except in case of fraud or a claim for an excluded treatment.

Payment of insurance instalments in equal amounts over regular intervals is now allowed. Lump-sum payment is not a must.