Health insurers will have to guide policyholders on portability

IRDAI has proposed the introduction of a standardized customer information sheet in health insurance policies, a document that guides policyholders on policy coverage and features.

The proposed information sheet is simple and aims to explicitly disclose what’s covered and not covered. IRDAI said, “To ensure that the health insurance policy information is provided in a simple and easily understandable language, it is proposed to revisit the customer information sheet.”

Among the key highlights is a guidance note on exercising portability. Further, insurers will have to specify the process to port or migrate to other insurers.

Here are some key highlights of the new customer information sheet:

• Policy has to mention if the policy will give coverage up to sum insured or fixed cost or both
• Sum insured for each member
• Details on expenses that will be covered like admission beyond 2-24 hours, specific procedures, OPD or maternity expenses and so on
• List of exclusions including waiting period and pre-existing condition
• Disclose sub limit and copayment with examples for easy comprehension
• Give turnaround time for claim settlement. Also, give guidance on claim procedure
• Details on call center number and company officials to be contacted in emergency
• Share details of grievance redressal officer, company’s grievance portal and ombudsman
• Disclaimer on free lock period

Interestingly, policyholders will have to sign a declaration that they are not hiding any pre-existing condition.

Shashi Kant Dahuja, Chief Underwriting Officer, Shriram General Insurance believes that the move will improve transparency and enhance policyholder’s experience. “Most of the policyholders of health insurance lose their trust in their insurance company when the insurer says that their claim is not payable by giving citing certain technical clauses mentioned in the policy wording. Whenever the policyholders purchase health insurance products, they often regret their decision to buy health insurance because of misinformation provided to them. The proposed exposure draft is totally in favor of the customer and the same will help the customer to know their rights as well as the features of the policy in a very simple and plain language.  It will bring more trust among policyholders and will definitely bring positive change to the insurance industry.”

You can submit your comment on this proposal to IRDAI through email at g.rajeshwar@irdai.gov.in latest by September 13.