Why are insurance companies changing the rules?

Siddharth Singhal, Head of Health Insurance at Policybazaar, said, “The development in medical technology in the last decade has completely changed the process of treatment and surgery. Now patients do not need to stay in the hospital for a long time.”

Earlier, procedures like cataract, chemotherapy and angiography also required overnight hospital stay. But due to minimally invasive techniques and better diagnostics, these treatments are now possible in just a few hours. Accordingly, insurance companies are also changing their rules.

Short-stay coverage is also included in the policy

Many insurance companies have updated their policies and included short-duration hospitalization in the coverage. Singhal said, “Now there are many policies that accept claims even for just two hours of hospitalization. There is no need for any additional condition or exclusion.”

Facility available in these major schemes

ICICI Lombard’s Elevate plan

Supreme plan of CARE Health

Niva Bupa’s Health ReAssure Plan

For example, if a 30-year-old non-smoker lives in a metro city, the annual premium for a ₹10 lakh insurance plan would be ₹9,195 for ICICI Lombard Elevate plan, ₹12,790 for CARE Supreme and ₹14,199 for Niva Bupa Health ReAssure. Experts believe that this initiative of insurance companies is not only providing better facilities to patients but is also making the health system more resilient over time.

What are the rights of a health insurance buyer?

A health insurance taker has the right to receive timely treatment and claim facility as per the coverage decided under the policy. He should get complete information about all the terms and conditions of the policy, coverage, exclusions and claim process with transparency.

The policyholder also has the right to cashless facility, option to choose network hospital, right to know the reason and appeal in case of claim rejection. Also, the insured person has the right to avail the benefits of policy renewal, portability and free-look period.

What is health insurance?

Health insurance is an insurance plan that covers the insured’s medical expenses such as treatment, hospitalization, surgery and medicines. In this, the insured person pays a fixed premium annually and if needed, the insurance company pays the hospital bill or reimburses the expenses. Many plans also provide the facility of cashless treatment, so that the patient does not have to pay money.

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There is great news for all senior citizens aged 70 years or above. Now they will get free health cover of up to Rs 5 lakh every year, that too without any income or scheme eligibility condition. The name of this new benefit is Ayushman Vay Vandana Card, which was launched by Prime Minister Narendra Modi in October 2024. This card is an extension of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana and is especially for those elderly who have crossed the age of 70 years or above.

Its biggest advantage is that it covers about 2000 medical treatments, and there is no waiting period. Meaning every pre-existing condition is covered from day one.

What is Vaya Vandana Card?

This card provides a health cover of Rs 5 lakh every year to all those people who are 70 years of age or above. If someone is already taking advantage of the Ayushman Bharat PM-JAY scheme, then he will get an additional top-up of Rs 5 lakh. Those who already have a government or private health scheme will have to choose one of them. Even those who have a health cover from a private company are eligible for this scheme.

How to get Ayushman Vaya Vandana Card:

• First of all, download Ayushman app in your mobile from Google Play Store.
• Open the app and select the correct option between ‘Login as beneficiary’ or ‘operator’.
• Enter captcha, enter mobile number and choose authentication method.
• Login by entering OTP and captcha.
• Give the app permission to access the phone’s location.
• Now enter the beneficiary details – like state name and Aadhaar related information.
• If the name does not appear in the system, follow the e-KYC process and give consent for OTP.
• Give the declaration and fill the required fields.
• Enter beneficiary’s mobile number and OTP.
• Fill the remaining information including category and pin code.
• Add details of family members and submit.
• Once e-KYC is completed and approval is received, you can download your Ayushman Vaya Vandana card.

Which treatments will be covered?

With this card, treatments can be availed under 27 medical specialties including general medicine, general surgery, orthopedics, cardiology, oncology. Some special treatments like hemodialysis / peritoneal dialysis, acute ischemic stroke, total hip replacement, total knee replacement, PTCA, single / double chamber permanent pacemaker implantation are also included in it.

Where will the facilities be available?

Beneficiaries of Ayushman Vay Vandana Card can avail the benefits of this scheme in more than 30,072 hospitals across the country, including 13,352 private hospitals. And the most important thing is that all these treatments will be cashless. If you or someone in your family is 70 years or above, then definitely take advantage of this health cover. This is not just a card, but freedom of health care.

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GST on Health Insurance: A big meeting of the Goods and Services Tax (GST) Council is going to be held on Monday, September 9, 2024. It is believed that in this meeting a decision can be taken regarding GST on health insurance. If sources are to be believed, the Fitment Committee is not in favor of giving complete GST exemption on premium. However, some suggestions have been given to the Council by the Committee and the final decision has been left to the Council.

Let us tell you that the Fitment Committee includes revenue officers of both the Central and State Governments. At present, the committee has given some options to the Council and left the decision to it. Along with this, it has also been told that what kind of impact can be seen on the revenue on choosing those options. If sources are to be believed, tax cuts are being considered in any one of the four ways on health insurance. The fitment committee believes that the cuts should be made only when the life insurance company gives benefits to the insured. It is being told that the council can consider giving rate cuts in life insurance only for term and re-insurance.

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Nitin Gadkari has also made this demand

Let us tell you that Union Road and Transport Minister Nitin Gadkari has urged the government to withdraw GST on insurance. West Bengal CM Mamata Banerjee has also reiterated this demand and demanded relief to the common man. Let us tell you that GST is an indirect tax. GST, implemented on 1 July 2017 during the first term of the Modi government, has brought about a major change in the country’s tax system. Since its introduction, a single tax is imposed in place of different taxes across the country.

Before the implementation of GST, 15% tax was levied on term or life insurance and medical insurance. But after the implementation of GST, it increased by 3% and GST started being levied on these insurances at the rate of 18%. The increase in tax by 3% had a direct impact on the premium of insurance policies and its prices increased. However, arguments are given in favour of GST by talking about the facility of tax exemption in this regard.

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The Union Health Ministry has proposed to double the insurance cover under the Ayushman Bharat Yojana to Rs 10 lakh and Rs 15 lakh for women. The proposal has been prepared by the Group of Secretaries (GoS) on the Social Sector and has been included in the key priorities of the Union Health Ministry for the next five years.

The ministry also plans to increase the number of beds in private hospitals. Currently, there are about 7.22 lakh private hospital beds under Ayushman Bharat, i.e. Pradhan Mantri Jan Arogya Yojana. It is proposed to increase it to 9.32 lakh by 2026-27 and 11.12 lakh by 2028-29.

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Ayushman Bharat Yojana, also known as Pradhan Mantri Jan Arogya Yojana (PM-JAY), currently provides an annual insurance cover of Rs 5 lakh per family. The scheme covers about 55 crore people in the country, which is 40 percent of the total population. According to the new proposal, the insurance cover will be increased to Rs 10 lakh per family, and in case of special diseases, this cover can be increased to Rs 15 lakh for women. Along with this, the target has been set to increase the number of beneficiaries from 55 crore to 100 crore.

Recommendations will be sent to the Finance Ministry

According to a report by the Indian Express, this proposal is based on the recommendations of a committee headed by NITI Aayog member VK Paul. Based on the committee’s report, this proposal will be formalized and sent to the Finance Ministry and the Cabinet for approval.

The BJP considers the Ayushman Bharat scheme as one of the successes of the NDA government and the party’s manifesto for the Lok Sabha elections this year promises to extend its coverage to all citizens above the age of 70. Various groups of secretaries have been tasked with mapping the goals from the BJP’s ‘Sankalp Patra’ and incorporating these into the election timelines. Earlier this year, a panel was set up to evaluate the implementation of the Ayushman Bharat scheme and reduce fraud. The panel is expected to submit its report within a month.

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The insurance regulatory body said that retail policyholders can cancel the insurance policy at any time during the policy period by informing the insurance company and get a refund for the remaining policy period. Announcing several reforms in the insurance sector, IRDAI said, “If the policyholder cancels the policy, he does not need to give the reason for cancellation.

Insurance regulator IRDAI said, “If the customer cancels the policy, the insurer should refund the proportionate premium for the expired policy term if the policy term is up to one year and no claim has been made during the policy term.

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Claim will not be rejected due to lack of documents

In addition, the Insurance Regulatory and Development Authority of India (IRDAI) said that general insurance companies cannot reject claims in the absence of any documents. The master circular issued in this regard, which is part of the reforms in the general insurance business, will usher in a new era for simple and customer-centric insurance solutions.

The comprehensive master circular on general insurance business also repeals 13 other circulars. The circular states that no claim will be rejected due to lack of documents. According to this, customers can be asked to submit only those documents which are necessary and related to claim settlement.

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Now you will not have to wait much for health insurance claims. Soon all health insurance claims will be processed by hospitals and insurance companies through a single window National Health Claim Exchange i.e. NHCX. This will speed up your claim settlement process.

Health Ministry sources said that the NHCX, developed by the National Health Authority (NHA), is ready and is currently undergoing trials. Sources said, “The portal is likely to be available across India from the time of launch. The government has initially linked about 50 insurance companies and 250 hospitals to it and gradually more hospitals and insurance providers will join it.”

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Workshops and meetings with representatives of insurance companies and hospitals
Before preparing the NHCX portal, the NHA conducted workshops and meetings with representatives of various insurance companies and hospitals. After this, the NHCX portal has been prepared.

Health insurance claims through a single platform

Insurance companies have different portals, which makes it cumbersome for hospitals, patients and other parties to settle claims. In such a situation, once the government’s NHCX is launched, health insurance claims will be processed through a single platform. Hospitals and insurance companies will check on this platform and this will speed up the process of claims.

The post Health Insurance: You will get health insurance money in a jiffy, government is bringing new portal first appeared on Rightsofemployees.com.

Health Insurance New Rules: Insurance regulator IRDAI (Insurance Regulatory and Development Authority of India) has removed the age limit of 65 years for individuals purchasing health insurance policies. IRDAI has done this with the aim of broadening the market and promoting adequate protection from health care expenses. IRDAI’s aim behind removing the maximum age limit for purchasing a health insurance policy is to promote a more inclusive and accessible healthcare ecosystem that ensures adequate protection against unexpected medical expenses.

As per earlier guidelines, individuals were allowed to buy a new insurance policy only up to the age of 65 years. But with the latest amendment anyone of any age is eligible to buy the new insurance policy. This amendment is effective from 1 April 2024. In a recent gazette notification, IRDAI said, ‘Insurers will ensure that they offer health insurance products to meet the needs of all age groups. Insurers may design products specifically for senior citizens, students, children, maternity and any other group specified by the competent authority.’

Insurers cannot cover people with chronic diseases.

Additionally, insurers have been ordered to provide health policies to individuals with any pre-existing medical condition. As a result, insurers are prohibited from refusing to issue policies to individuals with serious medical conditions such as cancer, heart or kidney failure, and AIDS. According to the notification, insurers are allowed to offer the facility of premium payment in installments for the convenience of policyholders.

There is no limit on coverage on these treatments

Travel policies can be offered only by general and health insurers. The notification states that there is no limit on AYUSH treatment coverage. Treatment under systems like Ayurveda, Yoga, Naturopathy, Unani, Siddha and Homeopathy will get coverage of sum insured without any limit. It also said that policyholders with benefit-based insurance can file multiple claims with different insurers, increasing flexibility and choice.

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But, the insured faces problems when companies reject the claim citing rules. One such rule is 24-hour hospitalization, without which you cannot take any medical claim. The insurance regulator has made a big change in this direction and given a gift to the customers.

Insurance Regulatory and Development Authority (IRDAI) has said that now it is not necessary to be admitted to the hospital for 24 hours to get a claim in medical insurance. Insurance companies will have to make separate provisions for this. This claim can be taken under day-care treatment and you can get the claim from your insurance company even without being admitted for 24 hours. This rule will provide a lot of convenience to the insured.

What has changed?

Insurance regulator IRDAI has also given a clear definition regarding hospitalization. IRDA has said that although for a claim, the insured patient will have to spend at least 24 hours under hospital care, in which some exceptions have been included. A new term called day-care has been added to it. Under this, such treatments will be included which will include conditions like any surgery being completed within 24 hours or anesthesia being used in it. In such cases, hospitalization for 24 hours will not be necessary.

Which treatments will be covered?

Under the new rules of IRDAI, certain types of treatments have been covered. Under this, if there is any treatment in which anesthesia is used, then claim can be taken even without spending 24 hours in the hospital. Such treatments include tonsil operation, chemotherapy, cataract operation, sinus operation, radiotherapy, hemodialysis, coronary angiography, skin transplantation and knee operation. Now the insurance holder does not need to be admitted for 24 hours for such treatment.

What will be its disadvantage?

Under day-care treatment, insurance companies will give you a claim without spending 24 hours in the hospital, but the insured will also have to bear some loss in this. Under this rule, doctor’s consultation fees, test and investigation expenses etc. will not be included. Outpatient care is also included in this category and after excluding some expenses, the insured can easily claim the rest. Recently, the consumer court of Gujarat gave its verdict against the insurance company in one such case, after which IRDAI has made a rule on this.

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Finance Minister Nirmala Sitharaman has shared many ways to save tax, through which you can save lakhs of rupees. Let us tell you how you can save tax up to Rs 8 lakh.

Apart from this, you will also get the benefit of exemption on home loan under section 24 (b) of the Income Tax Act . In this, you will get the benefit of exemption only on the interest paid on your behalf. You can claim tax exemption on interest up to Rs 2 lakh in this

Discount will be available on auto loan If you buy any electric vehicle under section 80EEB of the Income Tax Act and you have taken this vehicle on loan, then you will get a discount of up to Rs 1.5 lakh on it.

Exemption will be available in section 80C.

You can take advantage of the exemption of up to Rs 1.5 lakh under section 80C. Through this, you can claim exemption by investing money in many schemes including LIC policy, PPF, EPF, NSC.

Apart from all these, you will also get the benefit of exemption under 80C on the principal amount of the home loan. You cannot get more than Rs 1.5 lakh discount in this. Even if you have claimed any deduction earlier under 80C, you will get the maximum benefit of only 1.5 lakh.

You will get exemption from health insurance You can also save tax through health insurance. You can claim premium under section 80D. You get a discount of up to Rs 25,000 in this. If you have got your parents’ health insurance done, then you will get a full tax exemption of Rs 50,000.

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Preparations are being made to provide coverage of Ayushman Bharat Health Insurance to all the subscribers in the EPFO ​​board. This proposal can be approved by the end of this month. Let us tell you that under Ayushman Bharat Health Insurance, insurance coverage of up to Rs 5 lakh is given, that is, under this scheme, nothing goes out of your pocket on the expenditure of up to 5 lakhs.

Will not have to pay premium

It is being told in the proposal that the pensioners of EPFO ​​and their life partner will be considered entitled to this scheme. Subscribers of EPFO ​​will not have to pay premium for Ayushman scheme. In the proposal put up by the EPFO, it has been said that the premium of each subscriber, whose value is Rs 111, will be borne by the EPFO.

What is Ayushman Bharat Health Insurance Scheme

Ayushman Bharat Card was started by the Central Government to provide free health facilities to the people of the country. This scheme was started in September 2018. Under this scheme, every cardholder gets free treatment up to Rs 5 lakh.

This card is available to those people who are eligible for it. You can get it made both offline and online. Many types of facilities are available on Ayushman Bharat card. Chronic diseases are also covered under this plan. All the expenses before and after hospitalization are covered through this plan. Along with this, the expenses incurred through transport during treatment are also included.

EPFO subscribers get 7 lakh coverage

Employees Deposit Linked Insurance is an insurance scheme run by EPFO, which is run for every employee registered with EPFO. Under this scheme, an insurance cover of up to 7 lakhs is given. This scheme works with the combination of EPF and EPS. It is important for everyone to know about this, because if an employee dies during the job, then his nominee can get financial help of up to 7 lakhs under this scheme.

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