Patients may have to pay 10% of hospital bill even under cashless health policies, insurers propose
Under a proposal being readied by the General Insurance Council, policyholders would bear 10 per cent of hospitalisation costs even on cashless treatment.
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Health insurance rules are set for a major change. Under the proposed arrangement, patients would have to pay 10 per cent of their hospital expenses themselves even if they hold a cashless policy. The insurer would not pay the full bill.
In times of high prices, ordinary people buy health insurance to protect their families from misfortune. But they may now not get full relief even in a crisis. Insurance companies are preparing an important change that could cause sleepless nights for middle-class families. Ten per cent of the hospital expense would have to be paid by the patient, not the insurer.
The implication is plain. Alongside the illness, the stress of arranging money for the treatment of loved ones would grow. The new rule gives an example: if the total hospital expense is Rs 10 lakh, the insurer would pay only Rs 9 lakh and the patient would have to pay the rest.
The General Insurance Council, the representative body of all general and health insurance companies in the country, has nearly finalised the proposal. It will be sent to the insurance regulator IRDA for approval. According to the proposal, insurers will offer customers different policies keeping this 10 per cent rule in mind.
Under the new rule, those who pay a lower premium will have to bear hospitalisation costs from their own pockets. Those whose policies carry no deductible will have to pay a higher premium. This suggests that middle-class policyholders will end up losing out.
Cashless treatment will also attract a payment. The rule does not apply only to claims settled later, but also to cashless treatment available on admission to hospital.
There is no exemption for accidents either. Even when hospitalisation is caused by an accident rather than illness, 10 per cent of the expense will have to be paid by the patient. Only outpatient visits, that is OPD expenses, have been kept out of its purview.
Policyholders will also not be able to buy another insurance policy or a separate cover (rider) to pay this 10 per cent. The amount will have to be paid from their own pocket.
