When you don’t pay your renewal premium ahead of the date, coverage ends. You cannot renew, but have to approach it as a fresh policy. Your 30-day waiting period for making claims starts all over again and your (now) three-year waiting period for pre-existing conditions also resets. You may have to do some medical tests for underwriting and you may also be denied coverage.

There is some mercy though. You have a one-month window, a grace period, when you can still just pay the renewal premium and not lose all the above. What you would NOT get is claims for any hospitalisation in the interim period when there is no coverage. However, that and a few more significant terms and conditions were changed by the insurance regulator last month. Any claims during the grace period for renewal will also be payable even if the premium is yet to be paid. This is good because being covered one day and vulnerable the next is not a good feeling. It looks like a lottery that faults your memory or efficiency despite the fact that you may have had coverage for long years.

There are other significant benefits that the insureds get now and we will see some of them here. For accident or medical emergency admissions, the new mandate is that cashless authorisations have to be done by the insurer within one hour. The golden hour, as we know, can mean the difference between life and death for accident and other medical emergencies and this should not be frittered away chasing insurance approval.

Deposit requirement

Even though approvals are pursued by the hospital itself, the sad reality is that no actual work starts on the patient without the money materialising. A fat deposit would be the least requirement and this defeats the purpose of having a cashless policy. The time of discharge would be the next anxiety-prone period for any patient and his family, not the least because of payment of bills and the insurance claims process.

The regulator has now said that cashless claim authorisation should be given within three hours of receiving discharge notice from a hospital. The purpose is to expedite the discharge process and avoid unnecessary delays. Further, if there are additional hospital costs due to delay in cashless approval, the insurer has to bear them! Should the insured pass away during hospitalisation, insurers have been tasked with facilitating the immediate release of the deceased remains. By the sound of it this not only means they approve or make cashless payments expeditiously but also help with other formalities to help the bereaved family of the insured. Thoughtful measures and high time too.

(The writer is a business journalist specialising in insurance and corporate history)

Related Topics