Standardization of Health Insurance .
Applicable From 1st Oct 20 , all the health insurance / mediclaim policies across the country were to have standardized policy wordings , exclusions & waiting periods.
What does it mean for the policy holder & what were the changes being made?
Let’s see…..
What standardization means?
It means to have uniformity in the health insurance policy contract across all providers.
All the new conditions will be applicable to new policy holders & for existing policy holders were to come into effect on their immediate renewal.
The Changes being bought into ….
Key Inclusions
Modern Treatment Method covered with certain sub-limits,
Some of the indicative modern treatment methods are:
1) i. Uterine Artery Embolization and HIFU
2) ii. Balloon Sinuplasty
3) iii. Deep Brain stimulation
4) iv. Robotic surgeries
5) v. Oral Chemotherapy
An indicative list of some listed Conditions which will now be covered in Health Policies-
i. Mental Illness
ii. Neurodevelopment Disorders
iii. Parkinson’s & Alzheimer disease
iv. Age Related Macular Degeneration
v. Injury/Illness associated with hazardous activities
vi. Genetic Disorders etc.
For a total list of treatments included kindly go through the policy document, updated by the respective company.
further few more points...
1. Pre Existing condition will be defined as any illness, treatment, symptom, diagnosis or active line of treatment being treatment etc found 48 months before the contract would be pre existing so also if found within 3 months of the contract would be termed as pre existing hence will come under pre existing conditions.
2. Premiums could be paid in following modes, say monthly, quarterly, half- yearly.
3. There would be a Moratorium period applicable to health insurance policies where in, if the policy is run for 8 continuous years without at break there would be NO LOOK BACK APPLICABLE. These eight years are known as Moratorium Period. However, the policies would be subject to all limits, sub limits, co-payments, deductibles as per the policy contract even after the expiry of the moratorium period
4. The claim settlement will have to done in 30 days from the date of receipt of the last necessary document. In case of delay in payment of the claim, the insurer will be liable to pay interest @ 2% above the existing bank rate to the policy holder from the date of the receipt of the last necessary document to the date of settlement of the claim. If the claim requires investigation then it would be 45 days.
5. Expenses towards Tele Medicine would now be covered.
6. The list of Non Medical Items has been updated and certain items have been included in the cost of the Room and/or Procedure.
7. Proportionate deduction will not be applicable to medicines, diagnosis, and implants other than as termed associate medical charges. No proportionate deduction for ICU
8.There are 16 diseases / ailments which will are placed under permanent exclusion. Some of them are
Sarcoidosis
Malignant Neoplasams
Epilepsy
Heart ailment, congenital heart disease & valvular heart disease
Cerbovascular disease
Premiums were likely to be increased .
In regards to the same, kindly go through the policy document, for a total list of treatments & updates by the respective company or consult your advisor.
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