As of October 1, 2024, health insurance policies have become more favourable for customers.
Here are the key updates in health insurance regulations, making it easier to explain to potential buyers.
Key Updates in Health Insurance Policies:
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Shorter Waiting Period for Pre-Existing Conditions
The waiting period for pre-existing conditions has been reduced from 48 months to 36 months. After this period, insurance companies cannot reject claims for pre-existing conditions, even if the policyholder didn’t disclose the condition earlier.
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No Age Limit for Senior Citizens
Before, people over 65 couldn’t buy new health insurance. Now, there’s no age limit, so anyone—regardless of their age—can purchase a health policy.
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Inclusive Health Coverage
Insurance companies must now offer health insurance to mental health patients, special needs children, transgenders, and people with HIV/AIDS. This makes health insurance more inclusive.
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No Claim Denials After 5 Years
Insurance companies cannot deny claims after 5 years, even for reasons like non-disclosure or misrepresentation. However, if there’s proven fraud, the claim can still be contested in court.
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Meaningful Discounts for No Claims
If no claims are made during the year, policyholders can choose between increasing the sum insured or getting a discount on their premium for the next year.
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Refund Anytime
Policyholders can cancel their policy anytime and get a refund based on how long they used the policy. For example, if you pay Rs. 12,000 in premium and cancel after six months, you’ll get Rs. 6,000 back.
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Higher Claim Settlement Chances
IRDAI has asked insurance companies to set up a committee called Claims Review Committee (CRC). This committee will review the claims, which are rejected by the insurer.
Further, claim requests can only be rejected after approval of this committee. Also, insurers will have to give reason for rejection along concerning the specific terms and conditions of the policy document.
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Smoother Claim Settlement Process
Insurance companies and Third-Party Administrators (TPAs) must collect required documents directly from the hospital, so policyholders don’t have to submit them separately. Also, cashless claims should be processed within 1 hour, and final payments made within 3 hours of discharge.
At Mialtus Insurance Broking Pvt Ltd, we understand the challenges of maintaining good health and the importance of having comprehensive coverage. Contact us for the best health insurance policies and claim services. Our health insurance policies are designed to give you peace of mind, ensuring you and your family are protected during times of illness or medical emergencies. Call us on 8657528106 or visit our website to learn more about our customer-friendly health insurance plans.
Insurance is a legal agreement or a contract and a way to manage risk which is represented by a policy, under which the insurance provider agrees to provide the policyholder with protection or reimbursement against losses and damages with financial security or payment.
Insurance policies are used as a hedge against the risk of monetary losses both large and small that may cause damage to the insured or their property.
TYPES OF INSURANCE
Health Insurance
Health insurance is for people who have serious medical issues and need regular medical care, should look for this policy as it provides medical care at pocket-friendly rates.
Home Insurance
Home insurance protects the house of the owner from damages a theft. Many banks before keeping the house as a mortgage ask to have full insurance coverage of the property.
Motor/Bike insurance
Motor/Bike insurance offers protection to the car or any vehicle a person has invested in, just in case of accident, theft or damage by natural disaster. People pay annual premiums for auto insurance.
Life insurance
Life insurance is like a legal agreement between an insurer [person providing insurance} and a policy owner. This policy ensures the policy owner that the insurer will pay an amount to the people named as beneficiaries when the policyholder dies in exchange for the instalments of premiums paid by the policyholder during their lifetime.
Travel Insurance
Travel insurance covers the cost and losses associated with travelling domestically and abroad
Disability Insurance
Disability insurance shields families from financial difficulty when illness or accidents prohibit people from working. Many companies provide disability insurance or a person can buy their own policy.
The Process of Insurance Claiming
One of the most important and significant services an insurance company may offer to its clients is claim settlement. The faster resolution of claims is the responsibility of the insurance-providing company. An insurance claim is a formal request that is made by the policyholders to the insurance companies, asking for payment based on the conditions of the insurance policy. The company reviews the claim and the documents related to it to check its validity and then pays the amount to the requesting insured party.
The step-by-step procedures of Insurance claims are mentioned below: –
o Reach out to your broker
When it comes to one’s insurance policy, the broker involved in the policy is the point of contact as they are aware of the circumstances and know how to proceed. Once all the proofs are given to the broker of the damage or loss, i.e., photos and videos, an adjuster follows up the rest of the procedure and also identifies liable parties. Also, the party claiming may also provide witness for the same.
o Policy examination
The adjuster will carefully review the policy to determine what is and what isn’t covered under the insurance policy and inform the policyholder if any item is deductible or not from the claim.
o Damage evaluation
In order to calculate and evaluate the damages the insurance adjuster might work with appraisers, engineers or contractors to get the professional opinion and the adjuster can properly estimate the degree of the damage caused and might also give a list of recommended contractors to repair the damage. However, it is the will of the policyholder to get it repaired or claim the insurance.
o Payment is scheduled
The adjuster who has been throughout the process of claiming the policy and has examined everything will get in touch with the policyholder to discuss the settlement of the claim and payment. The complexity and gravity of your circumstances will determine how long will it take for the payment to be transferred to the party.
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