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


Star Health and Allied Insurance Co Ltd is focused on profitability and has imposed stricter conditions on its group insurance business. This with a view to reducing its losses and increasing its profitability. Under the new terms, the company will not settle expense claims at out-of-network hospitals.

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The restrictions will apply to pre-determined treatments and in case of emergencies and accidents, treatment will be allowed even in out-of-network hospitals, Shah said.

Due to the increase in claims from Star Health’s out-of-network hospitals and the company has no control over billing, the company has now asked the insured to pay for the pre-determined treatment in the out-of-network hospital itself. same.

Star Health has ties with 12,000 hospitals across the country where the cost of treatment is set by the company.

According to Star Health, under the contract of the group insurance policy. in the event of an emergency and accident, treatment is permitted at out-of-network hospitals, but all other predetermined treatment must be carried out at company-associated hospitals.

Because group insurance rates are set contractually and the company has no control over rates in hospitals outside the network.

Key pointers:

Star Health’s Focus on Loss Reduction in Group Policing

Non-settlement of claims for hospitalization outside the network

Connected to a network of 12,000 hospitals across the country

Group insurance company portfolio is over 1000 crore

In case of emergency and accident, treatment is possible in out-of-network hospitals

Claims from out-of-network hospitals have increased because the company does not have control over billing


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