Health insurance has now become a necessity for every person. After the Corona epidemic, the number of its users has also increased rapidly.
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.
