Category: Health Articles

New Rule: After 8 Years of Premium Payment Health Insurance Claim Becomes Non-Contestable

The worst nightmare for a health insurance policyholder would be the rejection of the claim by the insurer. There have been several advancements in medical science over the last few decades. Nothing seems impossible now; there is almost a cure to every disease that was considered incurable earlier. However, with medical science advancements, the cost of treatment has skyrocketed, and it has nearly become impossible for the middle class to afford the treatment. Health insurance is the only safety net now. So it will be challenging for the insured to settle claims if the health insurance company rejects or contests the claim.

To safeguard the policyholder’s interest, the Insurance Regulatory Development Authority of India (IRDAI) has issued new guidelines that will immunize policyholders from claim rejection. The guidelines’ main purpose is to standardize health insurance terms and conditions and make it simplified for a layman to understand.  

New Guidelines in Health Insurance Claim Settlement

IRDAI has set up new guidelines and introduced a moratorium period to safeguard claim rejection by insurance providers. The details of the new guidelines are mentioned below:

• -> Health insurance companies are not allowed to challenge claims for policyholders who have been paying the insurance premium for eight continuous years. This means that if a policyholder is paying for the insurance for eight consecutive years, then the claim will be settled easily.
• -> Any existing policy whose terms are not as per the new guidelines will have to modify the terms from 1st April 2021. So, whenever there is renewal on or after 1st April 2021, the terms will have to be revised.
• -> The eight-year duration is a trial period by the insurance companies, termed as the moratorium period. Insurance companies can judge the claims raised within the moratorium period, but any policyholder who has completed the moratorium period will be immune from claim rejection.
• -> The moratorium period is applied to the initial sum assured. It means if there is any enhancement in the sum assured, then the net enhancement will have to cover the moratorium period separately. For example, say the initial sum assured was 10 lacs on 1st Jan 2010, and after three years, the sum assured was increased to 15 lacs. The initial sum assured will have to complete eight years in 2018, and the increased sum assured of 5 lacs will complete its moratorium in 2021.
• -> In case of fraud or breach of trust on the policyholder’s part, the policy will be disqualified. There will be no benefit given to the policyholders.
• -> Policyholders can port the policy from one insurer to another. The portability should be done 45 days before the renewal date.

Conclusion

IRDAI is coming up with new guidelines to make the health insurance policy easily accessible to the masses. It is always advisable to read the guidelines and terms before purchasing a policy. Once an individual has complete knowledge, he/she will be able to utilize the policy optimally.

Probus Insurance allows the purchase of insurance policies online. Any individual will just have to enter his/her basic details, compare & choose the plan, pay online, and receive the policy in the inbox.

How to Lodge a Health Insurance Complaint

Like all products and services, health insurance policies also run into occasional challenges, and consumers have to raise their voice against their insurance provider. Given the sensitivity and criticality of health insurance and its impact on an individual’s financial ability, the sector is far more regulated than the more commonly used services. Insurance Regulatory and Development Authority of India (IRDAI) oversees all insurance providers’ functioning in India. In case of any lapses in their services to consumers, IRDAI can hold the insurer responsible and take appropriate action.

One thing to note is that IRDAI entertains complaints only from the insured person and not from any agents or third parties. There are multiple ways in which consumers can complain to their insurer, as listed below.

• -> Call the insurance company: This is often the quickest way to resolve a small issue (like an undelivered policy document, for example). All insurers have a customer care number on their policy document and official sites, which the consumer can use to connect with the company’s grievance redressal cell. It is good to insist on a ticket/reference number for the complaint so that there is an assured record of the complaint for any future follow-ups.
• -> Letter to the insurer: If the issue is serious or a phone complaint is impractical, the consumer can send a letter or email to the insurer, along with necessary supporting documents, addressing the insurer’s Grievance Redressal Officer (GRO). The addresses and email ids of every insurer’s GROs are listed on IRDAI’s website. The consumer must insist on getting an acknowledgment for the registered complaint.
• -> Take the complaint to IRDAI: If the insurer does not respond within 15 days of sending the letter, or if their response is unsatisfactory, the consumer can approach IRDAI by connecting with its Consumer Affairs Department’s Grievance Redressal Cell.

Consumers can either connect via phone with IRDAI Grievance Call Center (IGCC) via a toll-free number (155255 or 1800 4254 732) or by email (complaints@irdai.gov.in). IGCC also provides information to the consumers about the Insurance Ombudsman, who provides a fair resolution of complaints.

Consumers can also use IRDAI’s Integrated Grievance Management System (IGMS) for lodging their complaints. Consumers have to create their profile on the portal and can then make multiple complaints, as the case may be. The consumer gets an email confirmation along with a token number for tracking the complaint. Suppose the consumer remains dissatisfied with the insurer’s resolution, they can escalate the issue to be reviewed by IRDAI and can also see the remarks made by IRDAI in the matter.

Alternatively, consumers can also send a letter with the complaint details to IRDAI’s address (General Manager, IRDAI, Consumer Affairs Dept – Grievance Redressal Cell,
Sy No.115/1, Financial District, Nanakramguda, Gachibowli, Hyderabad-32).

To avoid getting caught in the hassle in the first place, consumers can avail of the services of leading insurance brokers, like Probus Insurance, which have a pan-India presence and expertise in the field, and provide the best advice on selecting the right health insurance company.

Difference Between Health Insurance and Life Insurance

“Uncertainty is the only certainty in life” is a phrase which most of us might have heard at least once. Anything can happen anytime in life, which is exactly what insurance is taken for. Let us have a closer look at the dilemma surrounding insurance and know the difference as well as the importance of life and health insurance.

Difference Between Health Insurance and Life Insurance

Let us dive deep to see the difference and need for life insurance and health insurance.

Life insurance

Life insurance aims to provide life cover to your family, dependents, or loved ones whom you, as the policyholder, have named nominees upon your untimely demise. An assured sum, known as a cover, is paid out as a death benefit to the nominees upon policyholder’s demise. This cover’s primary purpose is to provide adequate replacement income in the form of cover to the nominees and ensure that they do not face financial struggle upon your demise.

Health insurance

Health insurance is primarily aimed at covering your medical expenses, including doctor visits, hospitalisation costs, medications, tests, procedures, etc. Huge medical costs, especially upon hospitalisation and procedures, can even eradicate your lifelong savings in the absence of adequate and reliable health cover. Thus, purchasing health insurance for you and your family would help you bear medical bills and treatment costs whenever the situation arises.

 

Comparing the Two— Life Insurance v/s Health Insurance

Basis of Difference	Life Insurance	Health Insurance
Primary Aim	Life insurance aims to financially safeguard policyholder’s nominees in case of his/her untimely death.	Health insurance assists the policyholder in bearing medical costs such as hospitalisation, treatment, bills, etc.
Key Benefit	Life insurance pays death benefit to nominees in the form of the sum assured.	Health insurance covers various medical costs related to treatment, subject to the medical cover amount, and other underlying conditions.
Kinds of Plans	Life insurance involves term plans, child plan, retirement plan, etc.	Health insurance involves comprehensive health. insurance plans, critical illness cover, etc.
Add-on/Riders	Life insurance enables policyholders to top up the base cover by taking add-ons like maturity benefit, loyalty additions, surrender benefit, etc.	Health insurance holders can take advantage of No Claim Bonus (NCB), free health checkups, etc., in some policy types.
Income Tax Benefits	Life insurance premium can be claimed as tax deduction under Section 80C.	Health insurance premium can be claimed under Section 80D of the Income Tax Act.

Why Buy Insurance and Which One?

The reality is that, more often than not, most people require both types of insurance, especially if they have dependents like parents, spouse, and children. While making decisions regarding how to go about taking insurance, numerous parameters need to be factored in, such as existing assets and liabilities, the number of dependents, savings, etc. Both life insurance and health insurance have their specific roles to play and are essential for their respective benefits and purposes. Visit Probus Insurance to avail the best insurance plan suitable for you. Probus Insurance is a leading insurTech company that offers online insurance for health, life, vehicle etc.

Why is Health Insurance important in Our Life?

The COVID-19 pandemic serves as a good reminder inadequate financial planning leads to major financial upheaval due to medical expenses. Getting a good Health Insurance policy for yourself and your family should be a top priority. With the rising cost of medical and hospitalisation expenses, a health insurance policy will not only help you secure financial confidence but will also help you stay on top of the rising medical costs.

5 important reasons you should consider getting health insurance:

1)         To Protect Against Medical Inflation

The cost of medical treatment has been rising at an increasing pace. This includes the cost of the treatment and the costs of medical consultations, medicines, diagnostics, etc. Keeping up with these rising costs can be a huge burden. With a health insurance cover, you can seek quality treatment without worrying about the financial impact.

2)         To Protect against Lifestyle Diseases

Lifestyle diseases such as Diabetes, Heart Disease, Blood pressure, Cancer, etc., are increasing day by day. Such illnesses require early detection and constant care throughout one’s life; these are very expensive and hard to keep up financially. Having life insurance enables one to get regular check-ups without worrying about the cost.

3)         Coverage of Pre and Post Hospitalisation Expenses

With the rising costs of medical consultations, Outpatient Department (OPD) and diagnostic tests, such expenses can also significantly increase. Health insurance policies cover a certain period, usually up to 60 days, before and after your hospitalisation date. This will enable you to claim the entire cost you have incurred for medical treatment.

4)         Tax Benefits

Premium paid on health insurance is tax-deductible under section 80D of the income tax act. Up to an amount of INR 1 lakh depending on your and your families’ age. This insurance could translate to sizable savings on your tax bill if utilised wisely. Therefore, it is crucial to take the tax implications into account before deciding on an insurance plan.

5)         Other Benefits

There are several other benefits that a health insurance policy comes with, depending on the policy you choose. Such as,

Cashless Treatment – by which you will not have to chase the insurance company to claim your expenses,

No claim Bonus – that pays a certain bonus to the policyholder in case there has been no claim during the year,

Medical Checkup – Insurance policies permit you to get a periodic health check-up. Make sure you read the policy document carefully to understand what you are eligible for. Now that you are aware of the importance of having health insurance, it is imperative to research extensively before investing. With the various options to choose from, you must not get overwhelmed with the choices available and ensure that you pick the one that is a right fit for you and your family.

There are some things for which it is always the right time. Getting health insurance is one such thing. Our family’s well being is the most important thing in life, and it is also the main reason why many of us work long hours in demanding jobs. Unfortunately, it is increasingly expensive to take care of our medical needs, and no amount of savings seem adequate to take care of the unforeseen.

Getting health insurance is one of the best ways to address the financial concerns surrounding medical emergencies. It releases the pressure of arranging large sums of money at short notice; and in the event of illness, it allows us to take care of our own or our family’s health needs without having to run about for cash.

While there is no bad time to get health insurance, here are some pointers for when it is best to get a policy.

• -> On getting the first job: It is best to start young when it comes to insurance. The premiums are lower, and since there are usually few pre-existing health conditions, it is easier to get a health policy that covers a wide range of illnesses. Additionally, health insurance is a great way to save on tax.
• -> When getting married: Providing health cover to one’s spouse is the most practical way of taking responsibility. Joint covers optimize premiums, while taking substantial financial burden off each other in a marriage. Some policies also cover maternity related expenses; since most of them have a waiting period for claiming pregnancy cover, it is best to pre-plan and get health insurance around the time of the wedding itself. 
• -> On the birth of children: Most insurers provide family plans to include up to two minor children. Like with a spouse, getting a cover for children via a health policy is a wonderful way to take responsibility, and free oneself of the burden of financial planning for health. Especially in today’s world, where a child’s education is also financially demanding, getting a health policy for them will financially de-risk their health and wellbeing.
• -> On reaching middle age: As we age, our bodies require more attention and maintenance. Health insurance can ensure that we provide our body the support it needs. Many policies come with the feature of free annual health checkups, which is useful as we become older, and when our employers may not be there to provide us cover.

In a nutshell, it is always the right time to invest in health insurance, and the above milestones can be used to assess if we have provided for ourselves and our families.

Insurance is a way in which protection is provided against an uncertain eventuality. Therefore, health insurance is a protection against unforeseen health issues and related expenses.

Universally, people accept that health is wealth. However, it is not something to take for granted. Life is unpredictable, and one can inherit diseases or get them due to their lifestyle, occupation, or various other ways. Critical and life-threatening diseases are even harder to manage. Hospitalization is something everyone dreads, and apart from the physical toll, it can also take a financial toll on the person and their family.

Enter Health Insurance Plans. These are nothing short of a boon for millions of people, as they provide financial cover for illnesses, hospitalization, treatment, medicines, ambulance charges, etc., which can run up to huge numbers. Health insurance in India has been on the rise, going from 216 million to 473 million from 2014 to 2019 (source: Statista.com) in terms of overall people covered. This includes Government and state-sponsored health insurance. Private insurance has also been on the rise, with increasing awareness of the option to secure oneself financially in the case of health emergencies.

Benefits of health insurance

Let us understand specifically what the benefits of having health insurance are:

1. 1.Coverage of medical expenses: this is the main purpose of taking a health cover. Hospitalization, costs for surgery, daycare procedures, ambulance charges, and other associated expenses will all get covered by a good health insurance plan.
2. 2.Critical illnesses: the burden of expenses is very high in case of critical illnesses like kidney failure, cancer, organ transplants, etc.; they debilitate a person, sometimes disabling their ability to work and earn a living huge financial stress. Having an insurance plan helps protect the family’s immense financial distress should such unforeseen and unfortunate events happen.
3. 3.Cashless facility: a big benefit of health insurance is that they provide the option for a cashless claim facility. One does not need to pay at the hospital, except for a few non-reimbursable items, and the insurance company settles the claim directly with the hospital. There are a few rules and best practices to follow, however. The admission should be into a hospital within the insurer’s network, and sometimes a pre-authorization is required before filing the claim.
4. 4.Tax benefits: most types of insurance payments are eligible for a tax deduction. The amount of premium paid is eligible for deduction under Section 80 of the Income Tax Act, 1961.

Conclusion The rising costs of health, the increasing risks of lifestyles, and the unpredictability of health all make a good reason to take adequate health insurance for the entire family. In addition to life insurance, health is one of the most crucial insurances one must take, as it gives immense financial benefits in the form of covering hospitalization expenses and critical ailments, thereby reducing the financial burden on the families of people who are already reeling under the burden of managing the health conditions of the afflicted.

Things to Consider While Buying a Health Insurance Policy

Self-introspection

Are you amongst the mass who realized the importance of health insurance after an accident or hefty hospital bill or the most recent COVID-19 pandemic? Or are you still a sitting duck because of:

• – Unintelligible  policy jargon
• – Unknown territory operation with zero knowledge of insurance
• – Confusion among the innumerable choices

Do not worry. You are not alone. The real struggle starts not with the decision to get insured but with which policy.

So if you are looking forward to demystifying this daunting task of choosing the best health insurance policy, this article is just what you need.

Health insurance accounted for 29.7% of the total premium collected by the non-life insurer segment for April-September 2020 (Source: General Industry Council). The primary driver was individual policy.

Factors to Consider While Buying a Health Insurance Policy:

1. Maximum Insurance Coverage

Consider an investment in a health policy with maximum insurance coverage across everything. This includes hospital room-rent, ambulance cost, medicine bills, etc., and coverage for a wide range of diseases.

2. Hospital Network

Check how many hospitals the policy is applicable. The partnering hospitals with health insurance companies are known as hospital networks. The advantage with network hospitals is easy and stress-free advance deposits, cash payments, and freedom from excessive multiple paperwork. A policy with a greater hospital range (preferably renowned and successful ones) offers a wider scope of treatment and ease of operation at the time of emergencies.

3. Claim Settlement

Our ultimate aim from any policy is to gain maximum claim settlement with minimal effort. However, the insurance company might promise and deliver several benefits, coverage, and network but would lack in actual settlements. Therefore, to omit this marketing hoax, always check for the insurance providers’ claim settlement ratio. This data can be found on the company’s website – review settlement days, pending claims, and fully settled cases.

4. Consider all the Inclusions and Exclusions

Read the policy’s fine prints, i.e., the terms and conditions that contain the policy’s inclusions and exclusions. This would give you a fair idea about what you are looking forward to and if the expectations are completely aligned. Mostly diseases like HIV, AIDS, cosmetic surgeries, dental and cataract surgeries are excluded from policies.

5. Customer Feedback

In case you don’t understand any of the data, consider word of mouth as your guide. Read about the insurance company online and conduct a little research. Read customer reviews to gain a real picture.

Most importantly, prepare a comparative study of the health insurance policies available in the market as per your budget. Use parameters like premium, coverage, settlement ratio, customer feedback, and hospital network for informed decision-making. Make sure your money is worth it while the investment is fruitful.

Being a mother is every woman’s dream! While the physical journey has its joys and stressful times, the finances of parenthood can certainly burden the average couple looking to start a family. Most families plan for motherhood financially as well, since it can be an expensive affair, and requires them to dip into their savings.

There are several expenses during maternity; the nine months entail several checkups and doctor visits, dietary needs, and every kind of care that the mom-to-be needs. Birthing typically requires hospitalization for a minimum of 1-2 days and sometimes longer depending on whether there are complications. The newborn then has medical and several other needs for feeding, furniture, and so on, for which finances are required.

Inclusions and exclusions

While one should research the plans being offered by various insurance companies, in general, the following expenses are covered under maternity:

• – Pre hospitalization – 30 days for expenses such as diagnostics, consultations, and detection of congenital diseases
• – Post hospitalization – 60 days
• – Private room with A/C
• – Ambulance charges
• – In-patient care or daycare Vaccination expenses of the newborn

While bearing in mind what is reimbursable, one should also be aware of what the exclusions to the policy are. In general, the following expenses are exclusions:

• – Expenses on pre-existing ailments
• – Treatment relating to in-vitro fertilization and fertility treatments before pregnancy
• – Treatment of AIDS/HIV
• – Supplements such as vitamins taken during maternity

Important Factors

A couple of factors to keep in mind when taking maternity insurance are:

• -> Coverage: Check that the sum assured and sub-limit will indeed cover the expenses you anticipate for maternity in your city and choice of hospitals etc.
• -> Waiting period: Usually, after taking the maternity policy, there is a period during which you have to wait and cannot make a claim, typically nine months to 1 or 2 years. This is to discourage people from buying maternity policies after confirming or knowing about the pregnancy.
• -> Term of policy: The duration of cover may typically be 1-3 years, so check to ensure this is in line with your plans.
• -> Other terms and conditions: Do go through the terms and conditions thoroughly before committing to a policy. Also, there is a mandatory free look period of 15 days for all policies, hence use this time to make sure the terms and conditions are well understood and agreeable to you.

Conclusion

Maternity Insurance is available as a rider to a health plan or as a separate policy in itself. It is a blessing for those worried about the cost of birthing, hospitalization, and newborn related expenses. It takes care of removing the financial stress and allows the parents to peacefully enjoy the pregnancy and childbirth, which are undoubtedly precious moments in the life of every family!

Importance of Micro Health Insurance

India is a developing country, and recent data shows that about 364 million people live in multidimensional poverty. This indicates that insurance is still a big dream for millions of people, especially people living in rural areas. With no proper health insurance cover, in case of any untoward incident, people have to spend money from their savings or have to pledge jewellery or even sell their properties.

If there is any health insurance cover with a low premium, it will greatly help many people. This is where micro health insurance comes into the picture. With the current pandemic, people are more prone to illness, and hospital expenses are burgeoning with each passing day. With very minimal income, people in rural areas find it even more difficult to meet hospital expenses. Covid-19 has spread across the country, and having insurance covering the pandemic costs is a must in these trying times.

Micro health insurance products are reasonably priced as premium is very low, thus making it more affordable to the rural population. These days, it is becoming very difficult for a regular middle-class income group to pay an insurance premium, which comes to around Rs 15,000 for just Rs 3 lakh sum insured. With age, premiums differ; there are various micro health insurance schemes where the sum insured ranges from Rs 1 lakh to Rs 5 lakh.

With lifelong renewals, such products that come with family floaters help low-income households, and they no longer have to pledge or spend their hard-earned money on medical expenses.

What is covered under micro health insurance?

• -> Pre-hospitalisation charges
• -> Post-hospitalisation expenses
• -> Hospital expenses, if the patient is admitted for over 24 hours
• -> Some plans even cover ambulance costs and daycare treatments

Both state and central governments also offer various health insurance schemes keeping low-income households in mind. Notable among various schemes is Pradhan Mantri Jan Arogya Yojana (PMJAY) – Ayushman Bharat. This is said to have revolutionised the insurance market and a big boon to the rural population. Recently, the number of beneficiaries has crossed the 1 crore mark. Along with the government, private insurance players also offer micro health insurance as the Indian market is too big, and not everyone is covered under various schemes. The foremost requirement is to create awareness about health insurance products to the rural population. Often, people ignore them thinking they are not fall sick, and if they do, they can manage expenses later. But they end up straining their finances when they do end up in a hospital. Such micro-insurance products help poor people get affordable medical treatment, and they can heave a sigh of relief as they no longer need to concern themselves with medical costs.

Health Insurance Portability

There can be times when you feel dissatisfied with your current health insurance plan. The reason can be many, from lousy service to the annual premium being too high. Instead of feeling flustered, you can avail insurance portability. With its help, you can get rid of the issues you have with your current insurance provider.

In this article, we discuss health insurance portability and its benefits.

What is health insurance portability?

Health insurance portability refers to the shifting of your current policy from one insurance provider to another. It can be to avail better services or better plan at the existing premium outflow. The insured person gets a 30 days grace period to carry out the process conveniently.

Rules for health insurance portability

To avail the benefits of portability, follow the given set of rules –

• – The option is available only at the time of insurance renewal.
• – The new insurer can decide the terms and the premium of the policy, other than the waiting credit period.
• – The insured must inform the old insurer at least 45 days before his plans to port, information about the new provider, and renew the policy without a break.
• – The policyholder must not cancel the existing plan until he receives a confirmed plan from the new provider.
• – The policyholder can request the continuation of the existing policy from the current provider for a specific period in return for the premium on a pro-rata basis.

Documentation required for health insurance portability

The set of documents depends on the parties involved and their specific requirements. Here is the list of all the probable paperwork they might require –

• -> Identity proof
• -> Address proof
• -> Proposal form
• -> IRDA portability form
• -> Insurance policy
• -> Medical history
• -> Claims history (declaration if no claims have been availed yet)

Benefits

Health insurance portability affords the policyholder a myriad of benefits.

• -> You get the benefit of customizing the policy and inculcate specific things missing in your current plan.
• -> You often get the advantage of a lower premium with the same coverage from a new provider.
• -> You get to keep the existing benefits and avail additional services too.
• -> If you have a no-claim bonus amount pending, the new provider may consider and reduce your premium amount.

Probus Insurance Offers the Best Insurance Options If you are thinking of porting your insurance policy, you must consider all its pros and cons and then take a call. From home insurance to family insurance, we have a myriad of plans curated to suffice all your needs at the most reasonable premium outflow.