- Date : 30/10/2023
- Read: 3 mins
A look at the two new health insurance changes introduced by the IRDAI and how they will impact the policyholders and the industry.
Remember how we used to check the hospital network size of the insurer before buying a health policy? Not anymore. The Insurance Regulatory and Development Authority of India (IRDAI) is introducing a uniform network of hospitals as one of the two new important changes in health insurance.
Only 15% of Indians have received health insurance claims of more than Rs 1 lakh
3,276 health insurance claims reached their way to the Ombudsman in the financial year 2022
40 crore Indians do not have any health insurance coverage
The two new changes can restore more faith in health insurance
One List of Network Hospitals
Health insurance policy buyers often face the disappointment of realising that their preferred hospital is not part of the insurer’s network. To avoid this, policy buyers would go through the list of network hospitals carefully before selecting a health insurance policy.
Only 49% of hospitals in India offer cashless facilities. Many hospitals are dropped by insurers on suspicions of false or exorbitant billing and other malpractices. So, there is a chance that a hospital, which was a part of the common cashless network when you bought the policy, got dropped subsequently.
IRDAI is working with the General Insurance Council to prepare a national network of cashless hospitals. Firstly, the insurers will prepare a consolidated list of cashless hospitals. Then GIC will compile a national list, using which the body will ink an industry-level agreement with the hospitals and licensed insurers.
A committee will be in place for the empanelment of the hospitals. The committee will also work towards the standardisation of healthcare costs across the panelled hospitals, in a bid to bring in more uniformity in health insurance.
100% Cashless Health Insurance Settlement
Presently, a cashless health insurance claim involves 30-35% out-of-pocket expenses borne by the policyholder. IRDAI is working with insurers to introduce a 100% cashless settlement in health insurance. Presently, some ambiguity remains over how much of the total hospital cost would eventually be accepted as a claim by the insurer.
Video Embed: https://www.youtube.com/watch?v=qtr6SE2jWlQ
The common network will standardise medical costs within the network and promote competitive pricing. The 100% cash settlement will minimise malpractices prevalent in reimbursement processes. These steps may also reduce medical inflation and its effects on health insurance premiums, and minimise hospital expenses of the policy buyer.
The regulators are working towards introducing these changes by 1 January 2024. It is anticipated to be a win-win for both policyholders and insurance companies, with better claim experiences and reduced foul plays in claim processes.
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