Star Health tightens claim settlement rules in group insurance plans; claims for pre-determined treatment only in network hospitals

Star Health and Allied Insurance Co Ltd is focusing on profitability and has made some stricter conditions in its group insurance business. This is view of reducing its losses and increase profitability. Under the new conditions, the company will not settle claims of expenses in non-network hospitals. 

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The restrictions will be applicable to pre-determined treatments and in case of emergency and accidents, treatment will be allowed even in non-network hospitals, Shah said.

Due to increase in claims from non-network hospitals of Star Health and the company does not have control over the billing, the company has now asked the policyholder to pay for the pre-determined treatment in the non-network hospital itself.

Star Health has tie up with 12000 hospitals across the country where the cost of treatment is fixed by the company.

According to Star Health, under the terms of the contract of the group insurance policy. in case of emergency and accidents, treatment is allowed in non-network hospitals but all other pre-determined treatment should be done in the hospitals associated with the company. 

Because the prices of group insurance are fixed under contract and the company has no control over the prices in non-network hospitals.

Key Pointers:

Star Health's emphasis on reducing losses in group policy

Non-settlement of claim for non-network hospitalization

Connected to a network of 12000 hospitals across the country

Group Insurance company's portfolio is more than 1000 crores

In case of emergency and accidents, treatment is possible in non-network hospitals

Claims from non-network hospitals increased as the company does not have control over the billing