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After removing entry age from buying health policies and reducing the moratorium period i.e. period in which a claim request can be contested, IRDAI has made some more changes to the existing health insurance regulations to make it more customer friendly.
Among some key changes are giving more power to policyholders, creating 100% cashless claim settlement system and setting up a committee to review claim requests. Let us look at them:
- In a no claim year, policyholders can decide if they want to increase the sum insured or reduce the premium amount
- Policyholders can discontinue their health policy anytime and get a refund of premium based on a pro-rata basis. For instance, if your client has paid Rs.12,000 as the premium amount and decides to discontinue the policy after say six months, the client will get the refund of Rs.6000
- Insurers cannot deny renewal of policies on the ground of claims made during the preceding policy years. However, policies which are bought with fraudulent intention or non-disclosure do not fall under this
- Insurers to move towards facilitating 100% cashless claim settlement
- Insurers to prominently display claim settlement procedure to be followed under cashless and reimbursement of claims
- Insurers cannot harass policyholders by asking for documents. They need to collect it directly from the hospitals
- No claims can be rejected without approval of the Claims Review Committee
- Insurers will have to pay penalty of Rs.5000 per day if they do not implement order of ombudsman within 30 days
- No limit on sum insured for Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy (AYUSH) treatment
IRDAI said these changes are a landmark effort to empower the policyholders, ensuring they receive the highest standards of care and service; fostering an environment of trust and transparency in the health insurance sector.
