Health Insurance · advanced
Advanced Health Insurance Concepts
Health insurance beyond the basics — portability and migration, the tax deduction and GST on premiums, loss ratios and renewal pricing, how TPAs and hospital networks work, the current regulatory framework, and telemedicine, wearables and AI.
- 01Portability Rules — IRDAI Guidelines, Process & TimelinePortability lets a policyholder move an indemnity health policy to another insurer while keeping the credits earned through continuous cover. This lesson gives the current timelines, what carries over, and what happens when the sum insured is increased.
- 02Migration vs Portability — Key DifferencesMigration and portability both let a policyholder change health cover without losing earned credits. Migration stays with the same insurer; portability moves to a different one. This lesson sets the two side by side.
- 03Health Insurance Taxation — Section 126 Deduction (old Section 80D) & GSTHow health insurance premiums are treated for tax: the deduction under section 126 of the Income-tax Act, 2025 (old section 80D), its limits, the payment-mode condition, the old-regime restriction, and GST on premiums.
- 04Loss Ratio & Its Impact on Renewal PremiumsThe incurred claims ratio, or loss ratio, shows how much of an insurer's earned premium goes out as claims. This lesson explains how it is calculated, how it leads to the combined ratio, and how it connects to premium reviews, solvency and product withdrawal.
- 05TPA (Third Party Administrator) — Role, Selection & PerformanceA Third Party Administrator services health policies on an insurer's behalf. This lesson explains what a TPA does and does not do, who stays answerable for a claim, the rule on TPA remuneration and the service timelines.
- 06Network Hospital Management — Empanelment & De-empanelmentA network hospital has an agreement with an insurer to treat policyholders on a cashless basis at agreed rates. This lesson covers empanelment and de-empanelment, who agrees the tariff, cashless versus reimbursement, and the one-hour and three-hour timelines.
- 07Health Insurance Regulatory Framework — IRDAI Circulars & UpdatesThe current rulebook for health insurance: the Acts, the 2024 regulations and Master Circulars, and the main rules a policyholder meets — free look, claim timelines, the moratorium and the routes for a complaint.
- 08Technology Trends in Health Insurance — Telemedicine, Wearables, AIHow technology is changing health insurance: telemedicine, wellness plans linked to wearable devices, artificial intelligence in underwriting and claims, and the regulatory sandbox — and what stays the same, namely that the policy wording decides cover and the insurer stays accountable.