Do You Know About The New Health Insurance Claims Norms Introduced In 2024?

Posted on: Sep 6, 2024 | 3 mins | Written by: HDFC ERGO Team

Do You Know About The New Health Insurance Claims Norms Introduced In 2024?

The year 2024 has streamlined health insurance claim rules, making it much easier for you to understand the processing of medical insurance. Be it critical illness insurance or any other type of regular health insurance, knowing the new steps of medical insurance claims processing has become very important. For example, nowadays, pre-authorisation is faster, and in times of emergency, you wouldn't have to wait too long. There is also a focus on digital documentation, so you will be able to submit claims much faster. These are changes to make your medical insurance easier and ensure that your claims are processed with ease.

Top 6 Changes in Health Insurance norms in FY2024:

The regulator has ensured that the customer’s interests are best kept in mind while making all these relevant changes, which would surely impact each person’s life positively.

1. Cashless Everywhere:

Probably one of the biggest changes in 2024 is that claims can now be cashless at any hospital, whether part of your insurer's network or not. Suppose you were admitted to a hospital that wasn't in your health insurance provider's network. Upfront payment was required, and you had to go through the tedious process of availing reimbursement. This could be a significant financial burden during emergencies.

How does it affect you?

Now, through the "Cashless Everywhere" rule, you can get cashless facilities in any hospital. Just imagine that you have gone out of your station and you are admitted to some non-network hospital in that unknown city. In such a scenario, you won't need to wait for reimbursement or pay first from your pocket anymore. This means that your health insurance provider is going to directly settle the bill with the hospital, hence saving you from handling large sums of money during such a crucial time in your life. This is a huge relief in medical insurance processing to ensure that, as much as possible, it goes through smoothly.

2. Pre-existing disease waiting period has been reduced from 4 to 3 years:

The second major change relates to the waiting period for pre-existing conditions. Now, if you have a pre-existing condition, whether it is diabetes or hypertension, it would not be covered under your health insurance policy for four years. Often, this used to leave you in a tight spot because you had to manage these conditions out of pocket for a pretty long time.

How does it affect you?

This is now brought down from four years to three years. If you have been continuing the treatment for any pre-existing condition, you will now be covered one year in advance. For example, if you purchase a health insurance policy in 2021, the condition will be covered in 2024 instead of 2025. This shorter waiting period mainly helps people who have been fighting chronic illnesses and makes health insurance more accessible and useful when required.

3. No limitations on Ayush treatments:

Interest in AYUSH treatments, Ayurveda, Yoga, Unani, Siddha, and Homeopathy, has grown many folds in India, with more and more people reaching out to these traditional methods for health and wellness. However, health insurance policies either had limitations or exclusions to cover these treatments up until 2024.

How does it affect you?

The new rules said that every insurer shall have a policy approved by the Board for covering AYUSH treatment without any limitations. This means that if you like getting alternate treatments in the form of Ayurveda or Homeopathy, your health insurance will now pay for them as it does for any other type of medical treatment, provided the conditions can be met. For instance, if you were to get treatment from an Ayurvedic doctor for some disease like arthritis, then your claim cannot be rejected on the grounds of treatment kind.

4. 3-hour cashless claim clearance:

There has been an improvement in the turn-around time for Cashless claim settlement. IRDAI has stipulated that claims have to be settled within three hours when an insurer receives them from the hospital at the time of discharge. Additionally, at the time of admission itself, the insurer is mandatorily required to process cashless claim requests within one hour.

How does it affect you?

This can prove advantageous in emergencies or if there happens to be a rush for you to get discharged. For instance, if you are being treated in a hospital, then you don't have to wait endlessly for insurance clearance in case you want to be discharged. Settlements processed faster reduce delays, ensure quicker discharges, and help in the processing of medical insurance claims more effectively.

5. The moratorium period was cut to 5 years:

A moratorium period is the time within which your insurer can contest a claim on grounds of nondisclosure or misrepresentation of information. This used to be eight years, where even after several years of paying premiums, under certain conditions, your insurer could contest your claims.

How does it affect you?

In 2024, this period of the moratorium has been reduced to five years. If you do not have any breaks in health insurance coverage for five consecutive years, including portability or migration to a new policy, your insurer cannot reject your claims, except in cases of proven fraud.

Suppose you have been continuously paying up since 2019, and the coverage has been uninterrupted; by 2024, your claims cannot be turned down on grounds of non-disclosure. This will lead to a reduced moratorium period, which improves the position of the policyholder and gives you peace of mind because all of your claims will be covered if you have paid the premium regularly for five years.

6. Claims with multiple insurers:

Another important change is the new rule allowing you to file a claim with multiple health insurance policies for a single hospitalisation. The coordination of claims under both policies is confusing and problematic and often gets delayed in settlement.

How does it affect you?

Now, assume you have two health insurance policies, one for ₹5 lakh and another for ₹10 lakh. Now, if you have to incur hospital expenses of ₹12 lakh, you can use both policies to cover the costs without hassle. The new rule will make medical insurance claims processing steps easier so that the full benefits of all policies owned need not be complicated in cases.

Conclusion

These six changes that come into force in 2024 can make a lot of difference in the way health insurance claims are processed in India. From smoothening cashless claim procedures to further reducing waiting periods and better coverage of treatments such as AYUSH, these updates bring a user-friendly touch to health insurance and make it more effective for you. These changes will, hence, be a better place and assure you as you go through the steps of medical insurance claims processing, allowing you to really focus on what matters most: your health.

FAQs

1. What if I have both health insurance and critical illness insurance?

If you have both health insurance and critical illness insurance, you can claim benefits from both policies. For example, if you’re diagnosed with a critical illness, your critical illness insurance will provide a lump sum, while your health insurance will cover hospitalisation and treatment costs. It’s essential to understand the medical insurance processing steps for each policy to ensure you maximise your benefits.

2. How do I file claims if I’m admitted to a non-network hospital?

With the new rules in 2024, you can now access cashless claims even at non-network hospitals. Simply inform your insurer, and they will handle the medical insurance processing directly with the hospital. This change in the medical insurance claims processing steps ensures that you don’t have to worry about paying upfront and then seeking reimbursement later.

3. Are there any changes in the documentation required for claims?

Yes, insurers are now focusing on digital documentation. This means you can submit your documents online, speeding up the medical insurance processing. For example, instead of physically submitting bills and reports, you can upload them through the insurer’s portal, making the entire process more convenient for you.

Disclaimer: The above information is for illustrative purposes only. For more details, please refer to the policy wordings and prospectus before concluding the sales.

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