2/ **Why was this needed**
Every plan has its own independently designed terms and conditions, especially exclusions. 🙄
It was difficult to understand & compare many of these wordings. This also resulted in unpleasant surprises & grievances during claims.
3/ IRDAI has been taking massive efforts to standardize health insurance products, making them easier to understand and compare, helping reducing confusion and grievances.
This is another effort from IRDAI. 💪💪
4/ **Important**
These changes are applicable to all policies - existing and new from today - 1st October 2020.
In case you already own a policy that is due for renewal, these changes may take effect at the time of renewal.
5/ **Standard definitions for 18 exclusions**
IRDAI standardized definitions of the 18 most common exclusions like pre-existing diseases etc.
These terms will now have standard wordings across all health insurance plans across the country.
6/ **Disallow❌ambiguous definitions**
For exclusions that do not form part of the standard definitions - IRDAI now disallows ambiguous words in defining exclusions - for instance, the exclusions now cannot use open-ended words like "such as", "indirectly related to"
7/ **Disallow❌ insurers to put certain exclusions**
Health insurance will now cover treatments like mental illnesses, artificial life maintenance, Internal congenital diseases, genetic disorders (these were earlier excluded)
8/ **8 years⏲️of moratorium**
Earlier, insurers canceled policies, rejected claims on the grounds of misrepresentation even after customers had paid premium for decades.
Now, insurers cannot contest the policy or its declarations after 8 yrs, unless they prove a fraud.
9/ *Widening access to health insurance*
Insurers found it unviable to give insurance with preexisting cover to ppl with a history of Cancer, Epilepsy even with 48 mth waiting period
Now, such people may get access to health insurance with a permanent exclusion on the disease
10/ **Modern😎Treatment like Stem Cell Therapy included**
Many insurers did not cover Oral Chemo, robotic surgeries, stem cell therapy, and many more modern treatments.
IRDAI lists down 12 modern treatments that will now be covered under all health insurance policies.
🚨 Why a ₹1 Crore health cover may NOT be enough once you hit 30!
In 1999, my dad was proud owner of a bumper health insurance cover!
Cover of 2 Lakhs. He found it adequate.
In 2010, I felt ₹10L was a decent enough cover.
Today, ₹1Cr still seems a bit of a stretch. But is it?
Let’s break it down. 🧵👇
1. India’s private healthcare is only getting more expensive.
The government spends just 2.1% of GDP on healthcare - one of the lowest in the world. Public hospitals are struggling, and most middle-class families don’t prefer to go there.
That leaves us with private hospitals, and we all know how expensive they are.
Why?
Because the demand for quality healthcare far exceeds supply.
Just look at the top hospitals wherever you live - there’s always a rush.
Beds are perenially unavailable.
(Have seen the MD of a giant company waiting at Hinduja hospital, Mumbai, with their family member, late night, patiently negotiating for a vacant bed. )
India has only
- 1 doctor for every 1,500 people
- 1 hospital bed for every 1,000 people - far below WHO’s recommended standards.
Every year HR sends an "insurance" email most ignore.
You shouldn't.
The email usually has a deck that covers:
• The benefits you are entitled to.
• The process to enrol family members.
• The process to enrol and pay for parents’ covers and top up covers.
• The terms and conditions - which are a lot, believe me (this is ignored the most!)
Employer health insurance benefits are smoooooth!
👉 It is easy to enroll.
👉 It covers maternity benefits.
👉 It covers pre-existing diseases, damn it!
👉 It is even easy to claim.
Patient hospitalized for 6 days
Insurer pays for 2 days - says no "active treatment" after 2nd day.
Doctor shares logic for the 6-day treatment.
Insurer still disagrees.
Should patients consult insurers before taking medical decisions?
Why do patients suffer for lack of medical regulations?
First, let's understand why this happens.
So, health insurance as per the contract will pay only in case when the hospitalization is
a) "Necessary" and
b) " requires active treatment"
Ok - so what is "Necessary" treatment?
It is when patient can only be treated at a hospital and not at home or in OPD.
For instance, say I meet with an accident, and break my hand.
Now, the doctor needs to apply plaster on my hand.
But say the doctor asks me to get hospitalized for a day - This won't be covered under health insurance.