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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Medicines and things needed for treatment will be available for free. Laboratory tests will be free. The wait of senior citizens aged 70 years and above waiting to get Ayushman Bharat card is over. It is reported that within a week they will start getting the benefit of coverage under Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY). News agency PTI has reported quoting sources that health coverage for senior citizens of all age groups aged 70 years and above under Ayushman Bharat is expected to start within a week. About 6 crore senior citizens will benefit from this scheme.

Registration will be done on PMJAY portal or Ayushman app

The agency report said that initially, registration of elderly people will be done on an experimental basis at selected places. Then later it will be expanded across the country. Sources said that this is an ‘application’ based scheme, for which people will have to register on PMJAY portal or Ayushman app. Sources said that any person aged 70 years or above will be eligible to apply for this scheme. There is no limit on their income in this. This scheme is for the elderly of all income groups.

Those who already have Ayushman card will have to apply again

The source also said that people who already have Ayushman card will have to apply for a new card again. Along with this, they will have to complete their e-KYC again. The official source said that there is no waiting period in this. Once the e-KYC is done, the use of Ayushman card will start immediately. Apart from this, if any state wants to expand or amend this scheme of the central government, then it depends on them.

Also Read: School Holiday Declared: Good news! 7 consecutive days holiday will start from this date, see notification here

Coverage to Government Employees

The government has also said that if any senior citizen aged 70 years or above is availing benefits of other health insurance schemes like Central Government Health Scheme (CGHS), Ex-Servicemen Contributory Health Scheme (ECHS), Employees State Insurance Scheme (ESIS) and Central Armed Police Forces (CAPF), then they can also opt for this Ayushman Bharat scheme.

Health cover for those with private health insurance

If someone has taken a private health insurance policy and their age is 70 years or above, then they can also avail the benefit of Ayushman Bharat Scheme.

Coverage of elderly husband and wife in a single card

Not only this, if both the husband and wife in a family are 70 years or older, then they will also get the benefit of Ayushman Bharat Yojana. They can also avail the benefit of additional top-up of Rs 5 lakh by making Ayushman card. But, the condition in this is that separate cards will not be issued for husband and wife, the insurance cover of Rs 5 lakh will be the same for both husband and wife.

Many facilities from Ayushman card

Those who have Ayushman card can get free medical checkup as well as free treatment and consultation from the doctor. If hospitalization is required in any special situation, then they will not have to pay money. Medicines and things needed for treatment will be available for free. Laboratory tests will be free. If there is a problem in staying during treatment, then accommodation facility will also be provided. Along with accommodation, food will also be provided. After getting discharged from the hospital, care will be provided for free for a day.

Treatment of many diseases with Ayushman card

Under the Ayushman Bharat scheme, major and serious diseases are treated for free. Diseases like cancer are also covered under it. Apart from this, diseases related to heart, kidney, lungs, breathing, cataract etc. are treated for free. Citizens of the country can get their treatment done for free in more than 29,000 hospitals listed in the country.

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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.

The post IRDAI Rules Changed: It is not necessary to be admitted to the hospital for 24 hours for a medical claim first appeared on Rightsofemployees.com.

This includes everything from hospitalization to rest and treatment. For this reason a long leave (Medical Leave) is required. In such a situation, a special step has been taken to help a person and to promote organ donation among the Central Government employees.

DoPT has said that in such cases government employees will be given 42 days leave. These special holidays have been offered to central employees. However, at present, the rule states that a maximum of 30 days can be sanctioned as special casual leave in a calendar year.

Who will get these holidays

These holidays to the Central Employees are effective from 25 April 2023 under the new system. The memorandum issued states that 42 days leave is applicable to government employees appointed to civil services and other posts of the Union of India in terms of Rule 2 of the Rules 1972. This means that this holiday will be available for Railway Employees, members of All India Services, casual or contractual employees etc.

Government employees get medical facilities

Apart from holidays for its employees, the central government also bears the cost of medicines, treatment of serious diseases and any kind of tests etc. The government provides medical allowance and facilities to the employees on the basis of need. At the same time, subsidy is also issued on medical expenses for some schemes.

The post Government employees: Big news! Now you will get 42 days leave, new rule applicable for employees first appeared on Rightsofemployees.com.