Health Insurance News

SBI General Insurance launches ‘Health Alpha’ with flexible coverage options

SBI General Insurance has introduced its flagship retail health insurance product, Health Alpha, offering customers over 50 coverage options and high flexibility to design customised plans. With the tagline Your Health. Your Cover. Your Way., the product aims to make healthcare protection more affordable and adaptable to individual needs.

Health Alpha offers a wide range of sum insured options, from ₹5 lakh to unlimited coverage, and allows policyholders to opt for long-term plans of up to five years with tenure-based discounts. The entry age starts at 18 years with no upper limit for adults, and from 91 days to 25 years for children.

SBI General said the product is designed to help customers safeguard against rising medical costs while ensuring comprehensive protection. The plan covers a broad range of medical and hospitalisation expenses and is positioned as a step toward personalised and accessible health insurance in India.

Bengal to deploy 110 ambulances for highway accident response

The West Bengal government will soon roll out 110 ambulances under the 108 Emergency Response Service to provide rapid medical aid to road accident victims along national and state highways. Of these, 35 ambulances will have advanced life support systems, while 75 will offer basic life support.

Each ambulance will be stationed at 50-km intervals and provide emergency care within a 25-km radius. Subhanjan Das, Director of the National Health Mission (NHM), said, “This new ambulance service is an effort to save lives during the golden hour. Pre-hospital care is the primary focus.”

In 2024, over 34,700 road accident victims were treated in the state, with 15,356 cases reported by April 2025. The government is also promoting the Good Samaritan policy to encourage bystanders to assist accident victims without fear of legal repercussions. The new fleet includes 40 ambulances owned by the health department.

Centre revises CGHS rates for 2,000 medical procedures after a decade

The Union Health Ministry has revised rates for nearly 2,000 medical procedures under the Central Government Health Services (CGHS) scheme for the first time since 2014. The new structure, effective October 13, introduces a multi-dimensional rate framework based on hospital accreditation, category, city classification, and ward entitlement.

Earlier, rates varied only between NABH-accredited and non-accredited hospitals, causing complaints from both patients and hospitals. Beneficiaries said empanelled hospitals often refused cashless treatment, forcing out-of-pocket payments. Hospitals argued that outdated rates ignored medical inflation.

Under the revised system, semi-private rooms form the base for package rates. Rates are 5% lower for general ward entitlements and 5% higher for private wards. Additionally, consultations at NABH or NABL-accredited hospitals will follow standard base rates, while non-accredited hospitals will charge 15% less. The overhaul aims to address long-pending concerns, ensuring fair reimbursement and improved patient access.

Can your claim be rejected after porting health insurance? Here’s what experts say

As health insurance portability gains traction among consumers, questions are being raised about the implications for claim settlement. According to experts, while policyholders have the right to switch insurers without losing benefits like waiting periods, the new insurer does have the right to scrutinise claims — especially if there are material discrepancies or non-disclosures during the porting process.

Industry professionals clarify that if the policyholder has declared all pre-existing conditions and completed waiting periods with the previous insurer, the new insurer generally honours these benefits. However, if any fresh illness arises or there is evidence of non-disclosure, claims could be rejected even under the new policy.

IRDAI guidelines mandate that the porting process must be completed within 45 days, and insurers are expected to maintain continuity in coverage. Consumers are advised to ensure all medical disclosures are made accurately while porting and to confirm acceptance from the new insurer before cancellation of the old policy.

High Court order brings hope for GST relief on bank retirees’ health insurance

A recent Kerala High Court order has raised hopes for thousands of bank retirees seeking relief from Goods and Services Tax (GST) on group health insurance premiums. The court observed that retirees, who are not employed by the banks anymore, should not be subjected to GST as if they were receiving a supply of service from the bank. The petitioners, all retired bank employees, argued that group insurance was a welfare measure and not a taxable supply under GST laws.

The court noted that the issue required deeper examination and directed authorities to reconsider the levy of GST on such policies. While the verdict is specific to the petitioners, it may serve as a precedent for similar cases across the country.

Bank retirees’ associations have welcomed the judgment, stating that GST on health premiums significantly burdens elderly policyholders. The decision is expected to influence future regulatory clarifications and policy decisions.

Decoding ‘reasonable and customary’ clause in health insurance policies

The “reasonable and customary” clause in health insurance policies is increasingly drawing attention for its impact on claims settlements. This clause allows insurers to cap reimbursements based on the average cost of a medical procedure in a given geographic area, regardless of what a hospital actually charges. If a hospital’s fees are significantly higher than what is considered ‘reasonable’ by the insurer, the policyholder may have to bear the additional cost.

Experts say this clause is a standard cost-containment measure but can be opaque to many consumers. Its implementation varies between insurers and often leads to disputes during claims, especially for procedures conducted in premium hospitals.

Policyholders are advised to read their policy wording carefully, especially the fine print around terms like ‘reasonable,’ ‘customary,’ and ‘medically necessary.’ Transparency in how insurers arrive at such benchmarks is being called for to ensure fair treatment of customers.

Delayed discharges continue to trouble policyholders despite insurer-hospital tie-ups

Despite improvements in health insurance penetration and the growing adoption of cashless claims, delayed hospital discharges remain a major pain point for policyholders. These delays typically occur due to long turnaround times for final approvals from insurers after treatment is complete, often resulting in patients waiting several hours or even an entire day to be discharged.

Experts say that while digitisation and integrated claim processing have reduced delays to an extent, coordination gaps between hospitals and insurers persist. Insurers argue that final audits and checks are essential to avoid fraudulent claims, while hospitals often cite cumbersome documentation and approval protocols.

To address this issue, insurers and hospitals are increasingly signing service-level agreements (SLAs) that commit to fixed timelines for approvals. Some players are also exploring automated pre-discharge checks. However, real-time integration and trust between both parties will be key to resolving this friction and improving customer experience.