The Economic Times (ET) has reported that IRDAI has changed regulations on pre-existing diseases and emergency hospital admissions to benefit policyholders. Earlier, claims could be rejected if a person developed an ailment within three months of a policy issuance. Insurers say this resulted in uncertainty as neither policyholder nor the insurer could say definitely when a condition or a condition’s symptoms originated.
Earlier claims were admissible in a blacklisted hospital only in case of emergency accidents. This has now been extended to emergencies due to life-threatening conditions such as heart attack or stroke.
The new rules also replace an earlier condition where insurers could reject claims as pre-existing if diagnosed within the first three months of buying a health insurance policy. Conditions like hypertension, diabetes, respiratory ailments — which are more chronic in nature — earlier would not get covered if deemed pre-existing.
The National Health Authority (NHA) has blacklisted some hospitals for charging patients who were entitled to free treatment under Ayushman Bharat. Some hospitals also get blacklisted when they are found to be artificially inflating medical bills.
In addition to this, private and public sector insurance companies have their own internal list of blacklisted companies if they have indulged in corrupt practices.
An insurance official disclosed “Most hospitals would like to overcharge us. We have a rack-rate system to deal with it. We tend to ignore medical inflation in the range of 5-20%. In case of blacklisted hospitals, inflation is much higher — in range of 50%”.
IRDAI has also announced that insurers must cover expenses related to birth control. Earlier, the regulator allowed insurers to exclude covering any medical costs related to birth control, sterility and infertility treatments.
The Head of products at a private health insurer admitted on lack of clarity saying “Is it morning-after pills, abortion pills or an abortion (medical procedure) itself that will be covered going forward. Earlier, induced miscarriages and lawful medical termination of pregnancy were not covered. Does this change? We don’t know yet”.