If you have a group insurance policy from Star Health, your insurer may not settle the claim for non-network hospitalization. Star Health Insurance Company has informed its customers through an internal circular that, from this year, the insurer cannot entertain any claim arising out of a non-network hospital unless it is an emergency .
In case of medical emergencies and accidents, one can avail treatment in non-network hospitals and the policyholder can claim reimbursement from the insurer.
“We have introduced this clause because claims from non-network hospitals have increased over time, and we have no control over non-network hospitals, their billing, information, etc. Hence, revised the policy T&C Gone,” said. Star Health Senior Spokesperson Mint on condition of anonymity.
The e-mail sent to the customers read, “We would request you to kindly refer to the terms of our Group Insurance Policy regarding admission to non-network hospitals, which are as follows: Treatment in our network hospitals only, though medical In case of emergency and accident, the treatment can be done in other hospitals. In all cases, our call center will be informed immediately within 24 hours of hospitalization. Please be informed that in non-network hospital Any claim raised cannot be entertained unless it is an emergency. You will understand that these claim sheets are subject to scrutiny by the Statutory Auditors and IRDAI Regulatory Audit. Hence we have this provision to draw your attention to. And there is no option left except to mention that this clause will be strictly amended with effect from February 01, 2022.”
The clause was introduced in group insurance policies last year and is mentioned under the terms and conditions of the policy document.
Dr. S Prakash, Managing Director, Star Health and Allied Insurance said, “We are doing this for the benefit of the policyholder as we are not aware of the infrastructure, the expertise of the doctor, the facilities available in non-network hospitals. So when a patient Goes to a hospital. Network hospital, we can verify whether the patient needs special treatment or not. We confirm whether such treatment was required, whether surgery or ICU was required. All these things It is possible only when a patient goes to a network hospital.”
impact on policyholders
Experts have expressed concern about Star Health’s move. Mahaveer Chopra, Founder, CEO, Beshak.org said, “It seems that the insurer is largely limiting its group insurance coverage to its network to control the process and payment for not only cashless claims, but all claims. Is.”
“This may not be a problem for people living in cities where there may be enough and many nearby hospitals. However, people living in Tier 2 and beyond, especially those living in Tier 2 and beyond, now plan to have any hospitalisation. One has to look at the hospital network before making it. Treatment, which seems difficult, because hospitals are selected after consulting the treating doctor. This is a big change, and I hope there is enough awareness about this big restriction – So that customers do not get shocked after treatment.
Naval Goel, Founder and CEO, PolicyX.com, also expressed similar views, saying, “It is a bit restrictive for policyholders, though it will not affect most policyholders living in urban cities. However, it may be rural or rural areas.” May affect people living in the U.S. It can be cumbersome to find the nearest network hospital in the suburbs.” Also, you may not find better internet access in rural areas for searching network hospitals.
Don’t miss a story! Stay connected and informed with Mint.
download
Our App Now!!