Importance of Health Insurance
Importance of Health Insurance
Importance of Health Insurance
GI Council yearbook
Slide 3
• All the features that you get under your chosen health insurance
plan will be applicable to COVID-19 treatment.
• 24 hours hospitalization
• Sub limits
Pre existing disease-cataract/hernia/knee
/ Pre hospitalization expenses// Post
hospitalization expenses
Co pay/ Deductible / Network hospitals TPA
/Restoration of SI/Free Look period /
Migration Multiple policies
Cashless / Reimbursement
•Proportionate deduction: if the rent of the room taken by the insured exceeds the
rent covered in the policy, then the hospital bill is not reimbursed fully. The insurer
subjects the bill to 'proportionate deduction'.
•The proposed changes will benefit those policyholders who have sub-limits in their
health insurance policies. Majority of health insurance policies have sub-limits
associated medical expenses will be clearly defined if the deduction is to be
proposed but will not include :
•which include the cost of medicines,
•cost of implants and medical devices, and
•cost of diagnostics
•are not allowed to be part of the proportionate deduction;
•proportionate deduction would be applied only in case of a hospital that follows
differential billing practice based on the room category occupied by a patient.
Items not to excluded
•
IRDAI has also asked insurers to
simplify procedures, which means they
should not ask for too many documents
or conduct time-taking checks.
Most health policies offer a grace period of 30 days for
payment of renewal premium. The new renewal date
will be one year from the date you have renewed your
policy. For instance, if your policy renewal date was
April 15, 2020, and you renew your policy during the
grace period i.e. on May 15, 2020, then the new policy
renewal date will be May 15, 2021.
IRDAI has offered an additional grace period of 30 days, so that customers who use
offline payment modes like cheques are able to pay once the lockdown ends. This is
for Life health insurance policy holders.
IRDAI had also said earlier that COVID-19 cases should be
treated on a priority basis and before any claim for this
ailment is rejected, it should be reviewed by the claims
review committee (a high-level committee) of the insurer.
If a policyholder is not renewed even in the grace period, then the
policy lapses. No Claim Bonus and other benefits would not be included
if the policyholder wishes to renew/buy the policy again after the grace
period.“
can ask the policyholder to undergo the medical test if not renewed on
due date.
Simplify the procedures:
The regulator has also asked insurers to simplify the claims process for
COVID-19 deaths eg “If the claim form states that a death took place
due to COVID-19, no need to ask for additional documents. Claim can
be processed based on just a death certificate or a hospital document,”
Normally, insurers ask for treatment records, and sometimes they
investigate cases
• IRDAI has also asked all general and health
insurers to issue appropriate guidelines to their
respective TPA-n specifies norms on settlement/
rejection of claim by insurers
What are Insurers doing ?
• Our chat bot Cia is helping customers to renew policies, generate
claim status, send policy packs.Also engaging with the customers to
answer basic queries around covid-19 coverage.
Offering ( Go Active)
telemedicine and psychological
counselling
Telemedical check-ups for policy buyers
-would involve vetting of customer
applications and subsequent consultations
by doctors over the telephone.
Health care workers