Agents will have to ensure that their clients know what’s covered and what’s not in health policy

Health insurers will have to be more transparent in terms of disclosures. IRDAI has revised its customer information sheet (CIS), a document that guides policyholders on policy coverage and features like inclusions, exclusions, portability and grievance redressal mechanism. This will come into effect from January 1, 2024.

Interestingly, IRDAI has asked agents, intermediaries and insurers to ensure that their clients read the document. In fact, they will have to obtain an acknowledgement from their clients through physical or digital signature on CIS document before issuing a health policy.

The new information sheet is simple and aims to explicitly disclose what’s covered and what’s not covered. IRDAI said, “It is important for a policyholder to understand the terms and conditions of the policy that has been purchased. Since a policy document may be fraught with legalese, it is imperative to have a document that explains in simple words, the basic features with regard to the policy and provides necessary document.”

Debasish Panda believes that the move will reduce instances of grievances raised due to misunderstanding and misinformation on health policies. He was speaking at the BFSI summit conducted by Business Standard.

Among the key highlights of the revised CIS 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 centre 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.