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New Rules for Health & Mediclaim Insurance- IRDA Guidelines

The segment of health insurance is on the rise and will continue to follow the trend in the days to come. In the past few years, Indian people have grown to trust the assurance offered by the mediclaim insurance companies due to the elevating occurrence of various diseases. Simultaneously, the expense for the treatment of the ailments is also increasing due to the introduction of the latest technologies and advanced methods of treatment. 

Along with the exponential rise in the occurrence of the diseases, the demanding lifestyle is extracting every bit of earning, leaving you in a tight corner. Amidst such a scenario, if you or a member of your family encounter with a health trouble not only it leaves you bankrupt but also puts the health of the person at risk. Therefore, it is suggested to opt for the mediclaim insurance, which not only covers the ailments but also offers a peace of mind in exchange for a negligible amount of money. 

Importance of Health & Mediclaim Insurance

Gone are the days, when health didn’t hold any importance and was neglected for a prolonged period. Nowadays, people prefer to visit a physician in case of a mild headache and other minor concerns. As a result, the demand for the mediclaim has also increased. Have you ever encountered with a bitter experience while filing mediclaim insurance in case of an emergency? 

There are times when you have faced denial to enjoy any financial assistance. Though you feel comfortable to blame the authority, it is important to be aware of the latest rules implemented on the insurance policies by the IRDA or Insurance Regulatory and Development Authority of India. This is an apex body that regulates the comprehensive insurance businesses across the nation. Not only this takes care of the well-being of the policyholders, but also promotes and regulates the orderly expansion of the arena of insurance in India. 

Standardizing the Health Insurance Sector through the New Rules by IRDA

The segment of the health insurance is administered by the IRDA. This apex body was established with a set of rules, which are subject to change with the passing time. Not only this helps gain maximum benefit from the insurance policy but also reduces the hassle faced by the policyholders. However, due to the lack of proper knowledge about the changing rules for health and mediclaim insurance, you fail to neglect the inevitable harassment even in the crisis period. 

Guidelines of the IRDA Insurance

Some of the guidelines designed by the IRDA mediclaim insurance include pre-existing diseases, critical illness, hospitalization, and others. The apex body has already declared that the health insurance companies are bound to abide by the rules designed along with usage of the accurate terms. This will keep the ambiguities at bay while elevating the transparency between the insurance companies and policyholders. According to the general clauses of the health insurance mediclaim, the patient must be eligible to get admitted to the hospital, which has a certain number of inpatient beds, to enjoy the benefits of the insurance policy. 

The regulatory body has defined a set of guidelines to avoid confusions in the insurance policies. However, these change with the dynamic demands. Recently, they have altered the rules. Let us check the new rules implemented to ease the operation of the insurance across the nation, without any trouble. The following are the list of the items that are being removed or deleted from the list of items that were offered to the insurers in the form of optional cover:

  1. Expenses related to the dental treatments that don’t need any hospitalization. (Ref No.- 61)
  2. Therapy of hormone replacement. (Ref No.- 62)
  3. Expenses related to the procedure of assisted conception, infertility, and subfertility. (Ref No.- 64)
  4. Treatment for morbid obesity and general obesity if not specifically mentioned in the policy. (Ref No.- 65)
  5. Treatment for the psychosomatic and psychiatric disorder. (Ref No.- 66)
  6. Corrective surgery needed for refractive error. (Ref No.- 67)
  7. Therapeutic treatment for the STDs or Sexually Transmitted Diseases. (Ref No.- 68)
  8. Expenses related to the treatment that deals with the retrovirus or detected with HIV/AIDS directly or indirectly. (Ref No.- 73)
  9. Aesthetic surgery or treatment. (Ref No.- 177)
  10. Implantation, surgery, or storage of the stem cells. (Ref No.- 74)

The latest rules and guidelines mentioned by the IRDA regulatory body target to deplete the rate of fraud while increasing the satisfaction of the policyholders. Also, this will enhance the trust between the insurer and insured that will facilitate the progress of this sector.


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