Health Insurance Claim: Having a health insurance card often gives peace of mind. Many policyholders believe that once a health insurance policy is purchased, whenever they need treatment, the hospital bill will be paid automatically through the cashless facility. But it also needs to be kept in mind that approval does not always come automatically. Many factors determine whether a claim will be easily approved or will face hurdles.

But sometimes the situation can be very different from this. Every year, many policyholders face situations where their cashless claim gets rejected, partially approved or even rejected during hospitalization. In many cases, the policy is active and the premium has been paid on time. Yet, patients and their families suddenly find themselves scrambling to find money at a time when their entire focus should be on treatment and recovery. The reason for this is quite clear that merely having an active health insurance policy does not guarantee the success of a cashless claim.

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Why can there be problems in cashless claim?

The most interesting thing is that cashless health insurance is meant to make hospitalization operations better and less financially stressful, but there are certain situations where the operations do not go as expected.

According to Siddharth Singhal, Head, Health Insurance Business, Policybazaar.com, ‘Cashless health insurance aims to make hospitalization smarter and less financially stressful, but there are certain situations where even when the policy is active, cashless claims may get delayed, partially approved or rejected. In most cases, this decision is based on the policy terms and documentation requirements rather than the policy itself’. Also said that one of the main reasons for claim related problems is the stay restrictions.

The cost of every treatment is not covered by insurance.

According to the information received, many consumers assume that having health insurance will automatically cover every hospital expense. But it is not necessary.

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According to Singhal, ‘In some cases, the treatment or procedure may be outside the scope of insurance. Every policy has certain conditions and complaints. Some procedures, treatments or medical expenses are not covered under the policy. That’s why experts advise policyholders to read the policy wordings carefully instead of just focusing on the sum assured and premium.

Health Insurance Policy 2025: People often lose their entire life’s earnings due to serious diseases. A lot of money is spent in the treatment of serious diseases and their treatment lasts for a long time. At the same time, those who have taken a health insurance policy definitely get benefits. However, it is often seen that people do not take coverage of serious diseases in their health insurance policy. Due to which, if any serious illness occurs, they spend a large part of their savings in the treatment of the disease.

If you have also taken health insurance, then you should find out whether your health insurance policy provides cover for serious diseases or not? Even before taking health insurance, it is necessary to get information about it. So that you and your family do not face any kind of problem in future.

Must know things before choosing an insurance policy

If you are thinking of taking a health insurance policy, you should know whether it covers critical illnesses or not. Different types of insurance policies are offered by different companies. There is a difference in the premium also. Besides, companies also give policies regarding various diseases.

In many policies, cover is given for more than 100 diseases. While selecting your policy, you should choose such a policy which provides cover for serious diseases. If you have already taken the policy, you can also add it.

CI (Critical Illness) Rider

CI (Critical Illness) rider is an additional insurance coverage. Which can be added to the term life insurance policy. Under this, you get coverage for the treatment of serious diseases like cancer, stroke, heart attack, kidney failure and some surgeries. Under this coverage, a lump sum amount is paid to you.

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Lic Health Insurance: India’s government insurance company Life Insurance Corporation of India (LIC) on Tuesday informed the stock exchanges that it is in the final stages of negotiations to buy a ‘important’ stake in a standalone health insurance to increase its reach in the Health Insurance Segment. However, this stake will not be a mazority stake.

What did LIC say?

LIC Managing Director (MD) and Chief Executive Officer (CEO) Siddharth Mohanty told during an event that this deal is expected to be announced by the end of this financial year. He also clarified that no binding agreement has been reached so far. The deal will depend on LIC’s board of directors, regulatory approval and other approval.

Mohanty did not mention the name of the company, but made it clear that LIC would not buy more than 51 percent stake in any company. He said, “Our plans are. Discussion is in the final stages. Getting down in health insurance is a natural step for LIC. Since regulatory approval takes time, I hope that the decision can be taken by the end of this financial year.”

Status of Standalone Health Insurance in India

There are currently seven standalone health insurance in India-

• Star Health and Allied Insurance
• Neeva Bhupa Health Insurance
• Care Health Insurance
• Aditya Birla Health Insurance
• Manipal sign health insurance
• Narayan Health Insurance
• Galaxy Health Insurance

LIC sought 100 -year bond approval from RBI

Mohanty also informed that LIC has requested the Reserve Bank of India (RBI) to issue additional long-term bonds, including 100 years of bonds. He said, “We are long-term investors. We have contractual options, so we have to do asset liability management properly. Western countries have long-term bonds.” In November 2023, the RBI released a 50 -year bond, which was well liked by the Insurers and Pension Funds.

A look at the condition of health insurance in India

According to Forbes reports, in 2021, around 514 million people in India were covered under health insurance, which is only 37 percent of the country’s population. At the same time, about 400 million people have no facility of health insurance. 70 percent of the population is a cover under public or private health insurance, while 30 percent are without insurance.

In 2021, the Indian Health Insurance Industry gross Rit’s premium was more than Rs 637 billion. Talking about the states, Maharashtra topped the range of Rs 183 billion with a 32 per cent stake with a premium of Rs 183 billion. At the same time, according to the Economic Survey of 2022-23, the Government of India had 2.1 percent of GDP spent on Healthcare. In 2019, 48 percent of the total healthcare expenditure came from out-off-pocket payments, which is less than 64.2 percent in 2014.

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