One Hospital Bill Away? Know These 11 Health Insurance Rights

Health Insurance Rights: A staggering statistic, nearly 75% of Indian middle-class families could fall into poverty with just one hospital bill. Shockingly, most Indians hold health insurance yet still don’t know their essential rights.

IRDAI has defined 11 key rights for policyholders. However, many people remain unaware. Even those who know often miss the fine print. Follow this guide to protect your family and savings.

1. Lifelong Renewability

Your insurer must renew your policy for life—even if you’re older or become ill.
Exception: Renewal may be denied only in case of fraud or hiding crucial facts.

2. Portability

You can move to another insurer without losing benefits like waiting periods.
Tip: Port your policy while you’re healthy—some insurers may reject later requests.

3. No Claim-Based Loading

You cannot be charged higher premiums just because you made a claim.
Exception: Insurers may raise base rates for everyone but offer discounts to those who don’t claim—effectively penalizing claimants.

4. Moratorium Period

After five years of continuous coverage, your pre-existing illnesses cannot be excluded for minor overtime unless fraud is found.

5. Free-Look Period

You get 30 days from policy issuance to review and cancel if unsatisfied. You should get a refund, minus stamp duty or nominal charges.

6. Timely Cashless Claims

Since July 2024, insurers must approve or reject cashless hospitalisation within 1 hour. Delays can be escalated.

7. Compensation for Late Discharge

If your insurer delays approval beyond 3 hours, they must pay for the extra day. The funds come from shareholders—not your risk pool.

8. Pay Premium After Acceptance

From March 2025, insurers cannot deduct your premium until after they accept your application. If they reject you, your money refunds automatically.

9. 3-Month Notice on Changes

Your insurer must inform you at least 3 months before changing or hiking your policy terms. You can then exit or switch.

10. File a Grievance

If unhappy, file complaints with:

• The insurer’s own grievance cell
• IRDAI
• The Insurance Ombudsman
• Consumer forum, as last resort

11. Timely Payment After Ombudsman Order

Once the Ombudsman rules in your favour, the insurer must pay within 30 days, else they pay you ₹5,000 per day as penalty.

Why These Rights Matter

Investor Abhijit Chokshi says, “Knowing your rights isn’t optional—it’s essential. One hospital bill shouldn’t wipe out a family’s finances. Every policyholder should know what they are entitled to.”

Indeed, these rights protect your access and claims. They can save you from unfair denials, surprise charges, and unnecessary stress.

 What You Should Do Now

• Read your policy and check these 11 rights.
• Ask your insurer if any rule seems missing.
• Share this article with family and friends. Awareness creates protection.

Because if we all know our rights, we can transform health insurance from a gamble into a safety net—just as it should be.

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