IRDAI revamps health insurance norms; widening choices, improving affordability for policyholders
In a significant move towards the empowerment of policyholders and bolstering inclusive health insurance, the Insurance Regulatory and Development Authority of India (IRDAI) has announced a major revamp of regulatory norms.
The regulator has issued a comprehensive Master Circular on Health Insurance Products repealing 55 circulars.
All the entitlements in a health insurance policy available to a Policyholder have been brought in one place in the Master Circular.
It also emphasised measures towards providing seamless, faster and hassle-free claims experience to a policyholder procuring health insurance policy and ensuring enhanced service standards across the health insurance sector.
The major norms spelled out by IRDAI include a wider choice for the policyholders to be provided by the insurers by making available products/add-ons/riders by offering diverse insurance products catering to all ages, regions, occupational categories, medical conditions/ treatments, all types of Hospitals and Health Care Providers.
This is aimed at providing suitability and affordability. The insurers will also need to provide a Customer Information Sheet (CIS) along with every policy document.
It explains the basic features of insurance policies in simple words like type of insurance, sum insured, coverage details, exclusions, sub-limits, deductibles, and waiting periods.
Customers are also to be provided with the flexibility to choose products/add-ons/riders as per his/her medical conditions/specific needs.
A policyholder with multiple health insurance policies gets to choose the policy under which he/she can get the admissible claim amount.
‘The primary insurer with whom claim is first submitted should coordinate and facilitate settlement of balance amount from the other insurers,” IRDAI said.
In case of no claims during the policy period, the insurers may reward the policyholders by providing an option to choose such No Claim Bonus either by increasing the sum insured or discounting the premium amount.
Policyholder to get refund of premium/ proportionate premium for the unexpired policy period, if he chooses to cancel his/her policy at any time during the policy term.
A health insurance policy is renewable and shall not be denied on the ground that claim (s) was made in the preceding policy years, except in case of established fraud or non-disclosure or misrepresentation by the Insured, IRDAI said.