Month: September 2020

Having a health insurance policy with a sufficient sum insured is needed. How else would you be able to meet the expensive treatment costs of a medical emergency?

When you opt for an optimal sum insured level for complete coverage, you cannot overlook the premium associated with it. If a high sum insured is chosen, the premium, invariably, becomes high. In such cases, you have to choose between an optimal coverage and an affordable premium and the choice is not very easy. What if you can make your health insurance premiums affordable?

There are many ways in which you can save on your health insurance premiums. Let’s find out what these ways are –

• Following a healthy lifestyle

  Your health insurance premium is directly proportional to your health and your lifestyle habits. If you practice healthy living and choose healthy lifestyle habits, your premiums would be lower and vice-versa. So, you should maintain your health as premiums for healthy individuals with no medical complications tend to be lower than premiums for individuals suffering from medical problems. Similarly, if you smoke and/or drink, your health insurance premiums would be high as these habits impact your health negatively. That is why health insurance companies charge lower premiums from non-smokers than smokers.

• Wellness benefits offered by insurers

  The Insurance Regulatory and Development Authority of India (IRDAI) has asked insurance companies to include wellness benefits in their health insurance policies to promote healthy living. These benefits offer premium discounts if you are healthy or if you practice regular exercising and adopt healthy habits. These benefits also offer discounts on medicines and wellness programs at merchants partnered with the insurer. When buying a health insurance plan, look for these wellness benefits available in the policy and use these benefits to reduce your premium amount.

• Premium discounts

  Health insurance plans also allow different types of premium discounts in the policy for making the policy more pocket-friendly. Some of the commonly available discounts include the following –

  • Family discount for covering 2 or more members under the policy
  • Discount for buying a long term plan for a period of 2 or 3 consecutive years
  • Discount for buying the policy online
  • Discount for choosing voluntary co-payment under the plan

  You can hunt for these discount in the policy and use them to reduce your premium outgoes.

• Avoiding small claims

  When you don’t make claims in a policy year, you earn a no claim bonus. This bonus either increases the sum insured free of cost or it allows a discount in the renewal premium. So, during the policy year, if you incur small medical expenses, don’t make claims for such expenses. Avoidance of claims would help you avail no claim bonus and either get a higher sum insured at the same premium or a premium discount on renewal.

• Splitting the premium between spouses

  Health insurance premiums are allowed as a deduction from your taxable income up to INR 25,000 under Section 80D of the Income Tax Act, 1961. If, however, your health insurance premium is more than INR 25,000, you can split the premium with your spouse and claim double tax benefits. This splitting is allowed if the premium of the policy is paid through two bank accounts. In that case, the insurance company might issue two tax certificates allowing you and your spouse to claim a deduction from your respective taxable incomes. For instance, say your aggregate health insurance premium works out to be INR 35,000. In this case, you can pay INR 25,000 from your bank account and ask your spouse to pay the remaining INR 10,000 from his/her bank account. This way, you can claim a deduction of INR 25,000 under Section 80D from your taxable income and your spouse can claim a deduction of INR 10,000 from his/her taxable income. This splitting would, therefore, give you higher tax deductions and reduce your tax liability.

  Premium splitting might or might not be allowed by insurance companies. So, find out from your insurer whether it would allow such splitting and provide you with two tax certificates so that you can claim dual deductions on a single policy. (Source ET article)

• Choosing a super top-up plan

  To enjoy a high cover at a low premium you can opt for a super top-up health plan. The plan comes with a sum insured and a deductible limit. If the aggregate claims made in a policy year exceed the deductible limit, the excess claims are paid by the super top-up plan. A super top-up policy can act as a supplemental coverage on an existing plan. The deductible of the plan can be taken to match the existing coverage of your policy so that claims up to the deductible get paid by the existing health plan and excess claims get covered by the super top-up plan. A super top-up plan, therefore, is a good choice for increasing your coverage while reducing the premium cost.

Which of these ways would you choose to reduce your health insurance premium?

You can choose one or all of the ways mentioned above but do be smart about buying your health insurance policy. A high sum insured doesn’t always mean a high premium and you can use the above-mentioned steps to reduce the premium effectively. To enhance the sum insured, opt for super top-up plans and get comprehensive coverage which is also light on your pockets.

Watch the below video to find out more ways on how you can lower your health insurance premiums.

The Insurance Regulatory and Development Authority of India (IRDAI) has always ensured that health insurance plans adapt to the changing trends of the modern society. Gone are the days when health insurance plans offered vanilla coverage benefits against medical costs. Today’s health plans have become multi-dimensional in their scope. They offer new-age coverage benefits as well as value-added services so that policyholders can get something extra from their health insurance plans. IRDAI has also promoted the evolving changes in health insurance plans and one such change, in recent times, is the inclusion of wellness benefits in health plans.

Wellness and preventive healthcare can go a long way in taking care of your health and reducing the probability of health insurance claims for insurers. As such, some insurers offered incentives to policyholders for adopting a healthy lifestyle. Wellness benefits, which were previously offered by few health insurers, have been made universal by the recent IRDAI guidelines. These guidelines are asking insurance companies to include wellness related benefits in their health plans so that India can practice healthy living.

IRDAI guidelines – the talking points

IRDAI issued a set of guidelines for inclusion of wellness benefits in health insurance plans. These guidelines asked insurers to include the following benefits in their health insurance costs –

• Coverage for preventive healthcare

  To motivate policyholders to track their health on a regular basis, IRDAI asked insurance companies to allow policyholders coverage for preventive healthcare costs. Under preventive healthcare, insurers have been asked to provide coverage for the costs incurred in the following –

  • Health check-ups
  • Pharmaceuticals
  • Outpatient treatments
  • Diagnostic tests

  The coverage can be offered as a part of the policy benefits or insurance companies can offer discounts to policyholders on these costs. The coverage would, however, be provided if such costs are incurred at networked hospitals or empanelled hospitals of the insurance company.

• Benefits for wellness and healthy living

  Many individuals practice a healthy lifestyle and maintain their health. Insurance companies have been asked to reward such policyholders through wellness benefits in health insurance plans. This reward can be in the form of gift vouchers which policyholders can redeem on –

  • Health supplements
  • Sports club membership
  • Fitness centre membership
  • Gym membership
  • Yoga membership, etc.

  Furthermore, if policyholders practice healthy living during the policy tenure and fulfil the conditions of a wellness regime stipulated by the insurance company, they can be rewarded at the time of policy renewals. Insurers can offer such policyholders a discount in renewal premium or a free increase in the sum insured. 

  A very common example of this benefit is the ‘Stay Active’ benefit in HDFC Ergo Health plans. Under many of the company’s plans, if the insured takes a specified number of steps during the policy tenure, a premium discount is offered on renewal. 

• Coverage for excluded hospitalisation costs

  When you are hospitalized, your health insurance policy does not cover all the costs of such hospitalisation. However, IRDAI, in these guidelines, asked insurers to provide coverage against such excluded costs as a part of wellness related benefits.

IRDAI guidelines – the objective 

The primary objective of issuing these guidelines for inclusion of wellness benefits was to promote healthy living. Today, individuals are becoming increasingly conscious of their health and try and maintain a healthy life to keep illnesses away. With the introduction of wellness benefits in all health plans, IRDAI aims to –

• Increase the collective consciousness about healthy living among policyholders
• Motivate policyholders to look after their health to gain additional benefits from their health plans
• Reward those who practice healthy living
• Make health plans wellness-centric

IRDAI guidelines –the terms and conditions

While the afore-mentioned inclusions would considerably improve the scope of health plans and make wellness important, IRDAI also stated some terms and conditions associated with the coverage. These include the following – 

• The main objective of the afore-mentioned benefits should be to promote healthy living
• Insurance companies can set eligibility parameters for providing such wellness benefits. Policyholders would fulfil the parameters would be eligible to avail the wellness coverage benefits offered by the company
• Providing the wellness benefits would be the choice of the insurance company. The benefits can be inbuilt in the health plan or offered as an add-on
• Insurers can offer a range of wellness benefits and ask consumers to choose the benefits that they want
• The details of service providers tied-up with insurance companies to offer wellness benefits should be disclosed by the company on its website
• In case of family floater health plans, the plan should clearly state the members who can avail wellness benefits
• Many plans also offer the benefit of carrying forward the unused wellness coverage to the next year. If such a benefit is offered by a health plans, its terms and conditions should be clearly stated

The modern-day mantra is healthy living and IRDAI intends to make this mantra more popular by introducing wellness rewards in health insurance plans. This move would not only enhance the scope of health plans, it would also make them relevant in today’s times when health has become a priority. So, the next time you are on the lookout for a health insurance policy, find out the wellness benefits which different plans have to offer. Change your lifestyle to practice healthy living and get dual benefits – a fitter you and a rewarding health insurance policy.

Buying insurance plans has become quite simple due to the availability of the online platform which allows you to buy a policy from your home or office. Whenever you buy insurance whether online or through insurance agents, you are required to submit a set of documents to the insurance company. An insurance policy is a legal contract and thus, to establish the legality of the contract, insurance documents are needed. After the insurance company verifies the submitted documents, the insurance policy is issued. Moreover, at the time of an insurance claim, a specific set of documents would have to be submitted for claim settlement.

Since documents are important for buying insurance and also for making a claim, let’s have a look at the types of documents needed for insurance.

1. What are the documents required for buying insurance plans in India?
   Different documents are required to buy different types of insurance plans. So, let’s analyse the documents required to buy different types of insurance plans separately-
   • Life insurance
     To buy a life insurance policy, the following documents would be required-
   1. Life insurance proposal form, duly filled and signed by the proposer and/or the life insured
   2. Photograph of the proposer 
   3. Photograph of the life insured (if different from the proposer)
   4. Age proof of the proposer and/or the life insured 
   5. Identity proof of the proposer and/or the life insured
   6. Address proof of the proposer
   7. Medical examination report of the life insured if required by the policy because of the age and/or the sum assured chosen 
   8. Income proof of the proposer if the sum assured and/or the premium of the policy is high
   9. PAN card of the proposer
   • Health insurance
     For a health insurance plan, the following set of documents would be needed to be submitted –
   1. Health insurance proposal form, duly filled and signed by the proposer
   2. Identity proof of the proposer and the insured members
   3. Age proof of the insured members
   4. Address proof of the proposer and insured members
   5. Medical examination report if pre-entrance medical check-ups are specified by the insurance company due to the age and/or the sum insured chosen 
   6. Income proof of the proposer for very high sum insured levels
   • Motor insurance
     To buy a car or a bike insurance plan, the following insurance documents would be required –
   1. Proposal form for car or bike insurance, duly filled and signed by the vehicle owner
   2. Invoice of the vehicle if a new insurance policy is being bought
   3. RC book of the vehicle
   4. Identity proof of the proposer
   5. Address proof of the proposer
2. What are the documents required for insurance claim?
   In case of a claim in your insurance policy, the requirement of insurance documents would depend on the type of insurance policy that you have bought and the type of claim suffered. So, here is a look into the claim-related documents which would be needed in different types of insurance claims:
   • Life insurance claims
     Life insurance claims can be maturity claims, money back claims or death claims. The documents needed for maturity and money-back claims are the same while for death claims, the documents are different. Let’s understand how –
   1. Documents needed for maturity or survival claims
      1. Discharge voucher sent by the insurance company, duly filled and signed by the policyholder
      2. Life insurance policy bond
      3. Identity proof of the policyholder, legal heirs or assignee as the case may be
      4. Bank account details of the policyholder, legal heirs or assignee as the case may be
      5. Age proof of the insured member if it was not submitted at the time of buying the policy
   2. Documents needed for death claims
      1. The death claim form, duly filled and signed by the nominee
      2. Life insurance policy bond
      3. Death certificate of the life insured
      4. Identity proof of the nominee, legal heirs or assignee as the case may be
      5. Bank account details of the nominee, legal heirs or assignee as the case may be
      6. Police FIR if death happened due to an accident
      7. Post-mortem report, coroner’s report, police inquest report, panchnama and other relevant records if death happened in an accident
      8. Any other document as needed by the insurance company to settle the claim
   • Health insurance claims
     In the case of health insurance claims, the documents required for insurance claim are as follows –
   1. Pre-authorization claim form for cashless hospitalisation. This form should be filled and submitted within 24 hours of emergency hospitalisation. In case of planned hospitalisation, the form should be submitted at least 3-4 days before hospitalisation
   2. Health card issued by the insurance company
   3. Identity proof of the insured member
   4. The claim form, duly filled and signed by the policyholder
   5. Discharge summary or certificate of the patient
   6. All medical bills and reports in original
   7. Hospital records and investigative reports
   8. Medical prescriptions and cash invoice in original
   9. Police FIR or a Medico-Legal Certificate in case of accidental hospitalisation 
   10. Doctor’s prescription advising hospitalisation
   11. Reports of all attending medical practitioners
   12. Bank details of the policyholder in case of reimbursement claims
   13. Any other document as needed by the insurance company depending on the claim
   • Motor insurance claims
     In case of a car or bike insurance claim, the documents required for insurance claim are as follows –
   1. The claim form, duly filled and signed by the policyholder
   2. Identity proof of the policyholder 
   3. Driving license of the driver using the vehicle at the time of the accident
   4. Copy of the policy bond
   5. RC book of the insured vehicle 
   6. Tax receipt of the vehicle 
   7. Police FIR in case of third party claims or theft of the vehicle 
   8. Non-traceable certificate issued by the police authority in case of theft of the vehicle
   9. Invoice of the vehicle in case of theft or total loss or if required by the insurance company
   10. Surveyor’s report
   11. Bills of repair works issued by the garage and the payment receipts
   12. Bank details of the policyholder in case of reimbursement claims
   13. Any other document as needed by the insurance company for processing and settling the claim

These documents are necessary to buy an insurance policy or make a claim in it. You should, therefore, keep the documents handy in both these instances so that you can buy an insurance policy easily and also get the settlement of your insurance claims without any hassles.

Health insurance plans have become quite innovative in recent times as they are providing better and more inclusive coverage benefits. They are increasing the scope of coverage so that they can cover all possible types of medical expenses and the policyholders can enjoy complete coverage. One such coverage benefit, which is available in many health insurance plans, is the restoration of the sum insured. Let’s understand what this coverage benefit is all about –

What is the restore benefit in health insurance?

Restore benefit in health insurance is a coverage benefit which restores or refills the sum insured if it is exhausted on a previous claim. If in a policy year, you make a claim in your health insurance policy and use up the sum insured, the sum insured would be restored through the restore benefit so that in case of future claims the medical costs can be covered under the policy. For instance, if the policy has a sum insured of INR 5 lakhs and the coverage is used upon a claim, if there is another claim within the same policy year, the restoration benefit would restore the sum insured back to INR 5 lakhs. Thereafter, the restored sum insured can be used to meet subsequent claims which occur within the same policy year.

What are the types of restore benefit in health insurance?

Restore benefits in health insurance can come in two types. They are as follows –

1. Restoration on complete exhaustion of sum insured 

   If the health insurance policy provides a restore benefit in case of complete exhaustion of the sum insured, the restore benefit would work only if the sum insured is exhausted. If it is not, the restore benefit would not be applicable. For instance, say a health plan has a sum insured of INR 5 lakhs and a claim of INR 4 lakhs is made. After the claim is paid, the remaining sum insured is INR 1 lakh. If there is any further claim of INR 2 lakhs within the policy year, the restore benefit would not be applicable. INR 1 lakh would be paid by the remaining sum insured and the remaining INR 1 lakh would have to be paid by the policyholder.

2. Restoration on partial exhaustion of sum insured

   In a health insurance policy providing restore benefit on partial exhaustion of sum insured, there would be no need for the sum insured to be fully exhausted for the restore benefit to apply. The sum insured would be restored for future claims. For instance, in the above example, after the claim of INR 4 lakhs, INR 1 lakh sum insured would be left. The restore benefit would apply and the sum insured would be restored to INR 5 lakhs. For the future claim of INR 2 lakhs, the sum insured would be available to pay off the claim.

Benefits of restore benefit in sum insured

The restore benefit in health insurance is quite beneficial as it provides additional coverage. Here are some of the benefits of restore benefit –

1. Restore benefit increases the coverage available in your health insurance policy. You can enjoy additional sum insured under the policy through restore benefit
2. Many health insurance plans have an inbuilt restore benefit under the policy’s coverage benefits. Therefore, you are not required to pay an additional premium for availing the coverage
3. The restore benefit ensures that your health insurance policy would not fall short in meeting your health insurance claims
4. If you have a family floater health plan, the restore benefit is very beneficial. In such policies, the restore benefit ensures that the sum insured sufficiently covers all the members of your family. If the sum insured is used up by one member, the restored sum insured would ensure that the plan covers the medical expenses of another member if required.

Who should opt to restore benefit in health insurance?

Restore benefit is universally beneficial for all health insurance policyholders. It becomes especially relevant when you are buying a family floater policy to ensure optimal coverage for all members of the family. You can even opt for this coverage in case of individual health insurance plans for higher coverage. Moreover, if you have an existing illness and/or you are prone to illnesses and/or accidents, you should opt for the restore benefit so that in case of frequent claims, your sum insured would not fall short in covering your medical expenses.

Things to keep in mind about restore benefit in health insurance

Here are some important aspects of the sum insured restoration benefit which you should keep in mind if you are opting for this coverage benefit in your health insurance plan –

1. Availability 

   Under many health insurance plans, sum insured restoration features are inbuilt in the scope of coverage. It forms a part of the coverage benefits of the policy and you don’t have to opt for the coverage separately. However, under some health insurance plans, restoration benefit is available as an optional add-on. You are required to opt for this benefit by paying an additional coverage. So, when buying health insurance check out whether the restore benefit is inbuilt or optional.

2. Cost 

   Health insurance plans which have the restore benefit in their coverage features would cost more than plans which don’t. So, if you are buying a health plan with restore benefit, the premiums would be higher compared to a plan without restore benefit. The actual cost of the benefit depends on the insurance company and it is not very high.

3. Extent of restoration

   This is another important condition which you should check if your health plan has restored benefit. Under many plans, the restore benefit restores 100% of the base sum insured. Under some plans, however, restoration is allowed for up to 50% of the sum insured only. Additionally, there are plans which allow the sum insured to be restored by 200% through the accelerated restoration feature which is available as an add-on. For instance, if the sum insured is INR 5 lakhs and the restore benefit restores 100% of the sum insured, the sum insured would be restored by INR 5 lakhs upon exhaustion. In the case of 50% restore benefit, the restoration would be by INR 2.5 lakhs and in the case of 200%, the restoration would be by INR 10 lakhs. So, while the first plan would give you total coverage of INR 10 lakhs, the second one would give coverage of INR 7.5 lakhs and the third one INR 15 lakhs.

4. Application of restoration 

   There are some terms and conditions based on which the restore benefit applies. These include the following –

   • The restore benefit is not applicable to the first claim in a policy year. It becomes applicable to claims subsequent to the first claim. So, if you have a health plan of INR 5 lakhs and your first claim is INR 5.5 lakhs, the restore benefit would not give you an additional sum insured. In that case, you would have to pay INR 50,000 from your pockets. Thereafter, for any subsequent claim, the restore benefit would restore the sum insured and you would get a cover of INR 5 lakhs
   • Under many plans, the restore benefit might work only once in a policy year. Once it is used, it becomes invalid even if there are multiple claims thereafter. However, in some plans, the restore benefit can work a multiple number of times within the same policy year.
   • The restore benefit is allowed on unrelated illnesses. This means that the subsequent claim in the policy should be for a different illness or injury than the first wherein the sum insured was used up. If the subsequent claim is for the same illness or injury, the restore benefit might not apply.
5. Carry forward of the benefit

   If you do not use the restore benefit feature of your health insurance plan, it cannot be carried forward to the next policy year. 

The sum insured restoration benefit has become a common coverage feature of many new-age health insurance policies. It proves beneficial as it allows sufficient coverage in case of multiple claims. So, look for health plans with the restoration benefit feature for optimal coverage.

Frequently Asked Questions

1. What is the coverage duration of restore benefit?

   The restore benefit has the same coverage duration as that of the main policy. If the benefit is inbuilt in the coverage features, it would continue every year that the policy is renewed. If, however, you have opted for the benefit as an add-on, you would have to opt for the add-on every time the policy is renewed to enjoy continued coverage lifelong.

2. In a family floater health plan, one member makes a claim for heart attack and exhausts the sum insured. Would the restore benefit work if another member suffers a heart attack and makes a claim?

   The restore benefit works on subsequent claims and not on the first claim. Thus, if one member has made a first claim under the policy, the second member can make a subsequent claim under the policy and the restore benefit would work. Even if the claim is made for the same illness, the restore benefit would work provided that the second member makes a claim after the first claim has been made and settled.

3. My existing policy does not offer restore benefit. How can I avail coverage for restore benefit?

   You can buy an additional health insurance policy with restore benefit to get coverage for restore benefit if your existing plan does not offer such coverage. Alternatively, you can switch your current health insurance policy to another health insurance policy which offers coverage for restore benefit. This switching is called porting and this is available at the time of renewals.

4. Is the no claim bonus taken into consideration when restore benefit is applied?

   Yes, the no claim bonus is taken into consideration when restore benefit is applied. The restore benefit is applicable when the sum insured and the no claim bonus thereon is used upon a previous claim.

5. I suffer an accident and use up the sum insured in the first instance of a claim. Thereafter, I am hospitalised for an appendectomy. Would the restore benefit apply?

   Yes, the restore benefit would apply since the subsequent claim is for an unrelated illness. Your sum insured would be restored and the health insurance policy would cover the cost of appendectomy.

The Insurance Regulatory and Development Authority of India (IRDAII) continuously proposes changes in health insurance plans. These changes serve two purposes – 

• They help health insurance policies to adapt with the changing times
• They make health insurance plans more customer-friendly 

When COVID struck, IRDAI issued a series of guidelines to insurance companies to make COVID related claims as hassle-free as possible. Now, when health insurance plans have been offering complete help for COVID, IRDAI has proposed a series of new changes which would make health insurance plans more customer friendly. These changes should be incorporated by health insurance companies in the policies that they offer from October 2020. Let’s have a look at what these changes are –

Change#1 – Standardization of policy clauses

Insurance plans are technical in nature and the clauses mentioned in the policy document might prove confusing for many. Keeping this view in mind, IRDAI has asked health insurance companies to make their policy clauses standardized so that customers can understand them easily. These policies clauses should be stated in the wordings as provided by the IRDAI across all insurance companies.

What it means for you?

As policy clauses are standardized, they would become uniform across all health insurance plans. You would, therefore, be able to compare different plans easily without wondering if the plan that you choose has some hidden clauses which you should know. So, policy clauses like disclosure of important facts, grace period, health insurance portability, renewal, grievance redressal, policy cancellation, etc. would have the same definition across all health insurance plans. This would help you understand the policy better and compare different plans on their clauses easily.

Change#2 – Coverage for Telemedicine

Telemedicine means getting medical assistance from a distance using different modes of telecommunication. Under telemedicine, the doctor and the patient do not meet physically. Instead, they meet virtually. The concept of telemedicine gained popularity with the Coronavirus pandemic when visiting doctors and clinics for medical assistance became challenging due to lockdowns and social distancing norms. In today’s developing times, telemedicine has become a popular mode of availing medical assistance. With this development, IRDAI has also proposed that health insurance plans should cover the cost of telemedicine if the health plan provides coverage for normal consultations.

What it means for you?

The inclusion of telemedicine in your health insurance policy would increase the scope of coverage of the policy. It would eliminate your out-of-pocket expenses on telemedicine as the policy would cover such costs thereby making the health plan comprehensive and suitable for the current COVID crisis.

Change# 3 – To make proportionate deductions on room rent sub-limits more reasonable

The concept of proportionate deduction is applicable in case of room rent limits. If a health insurance plan has sub-limits on room rent, you are expected to choose a hospital room within the specified sub-limit for getting complete coverage under the policy. However, if you choose a room whose rent is higher than the prescribed limit, the total cost incurred on inpatient hospitalisation is reduced by the percentage by which the actual room rent exceeds the covered room rent.

For example, suppose the room rent sub-limit in your health insurance policy is Rs.4000. On hospitalisation, you choose a room with a rent of Rs.6000. This rent is 50% higher than the covered room rent. Thus, in this case, your inpatient hospitalisation bills would be reduced by 50% to calculate the admissible claim amount. This bill would include your room rent, doctor’s fee, surgeon’s fee, anaesthetist’s fee, cost of medical devices, medicines, etc. which are called ‘associate medical expenses’. So, if your bill amounts to Rs.2 lakhs, the insurance company would pay only Rs.1 lakh.

IRDAI has specified changes in this regard. It has asked insurance companies to define the meaning of ‘associate medical expenses’ clearly in their health insurance plans. The expenses, those fall under ‘associate medical expenses’ should be clearly stated in the policy. Moreover, IRDAI has asked insurance companies to exclude the following costs from the list of ‘associate medical expenses’ – 

• Diagnostics 
• Medical devices and implants used in the treatment
• Consumables
• Pharmacy

IRDAI has also asked insurers to remove proportionate deduction in case of hospitals which do not have different pricing policies for different categories of rooms and also for ICU admissions.

What is means for you?

This change is meaningful if you have room rent limits in your existing plan or you would buy a policy with such sub-limits. With the expenses clearly listed under ‘associate medical expenses’ you can easily understand which expenses would be impacted by the proportionate deduction in case the room rent limit is exceeded. Moreover, with the afore-mentioned exclusions from ‘associate medical expenses’, the scope of coverage of your health plan would increase. The proportionate deduction would be on a lower amount allowing you to get a higher amount of claim.

All these changes would be effective from 1st October 2020 on new policies. For existing policies, the changes would be applicable at the time of renewal provided that the renewal date is on or after 1st April 2021. 

These changes would make health insurance plans more comprehensive and favourable for policyholders and also increase the penetration of health insurance in India. So, be prepared to get enhanced benefits from health insurance plans starting this October. Happy insuring!