Listen to this article
IRDAI has made changes to health insurance regulations to make health insurance policies more customer friendly.
While IRDAI has made several changes like reduction in waiting period from 4 years to 3 years, move towards setting up a complete cashless claim settlement system and inclusion of treatments like Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy with the mainstream allopathy, we have listed five major developments in the health insurance regulations that can help you pitch health insurance policies more effectively. Let us look at them:
Senior citizen friendly policies
IRDAI has done away with the maximum age limit for insurers to sell health plans. So far, individuals could buy a fresh insurance policy till 65-years of age. With the new changes coming in, anyone regardless of their age can buy a new health policy.
In fact, the insurance regulator has asked health insurers to introduce targeted policies for specific segments like senior citizens.
The regulator has also instructed insurers to establish a separate channel to address the health insurance related claims and grievances of senior citizens.
Claim requests cannot be denied after 5 years
IRDAI clarified that no claims can be denied after 5 years. With this, no policy or claim can be contestable by the insurer on grounds of non-disclosure and misrepresentation after 5 years.
However, if an insurer establishes any fraud in a policy or claim request, such a policy or claim can be contested in the court of law even after 60 months.
Discounts and refund
If a client has not made a claim in a year, she can decide if she wants to increase the sum insured or reduce the premium amount.
Currently, general insurance companies give discounts during renewal of motor insurance policies for no claim. However, general insurers only extend the increase in sum insured in health policies, which typically remains unutilized.
Another important development is that 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.
Policyholders will have an option to discontinue the policy and get some refund whenever an insurer denies their claim request.
Rejection of claims get difficult
IRDAI asked insurance companies to set up a committee called Claims Review Committee (CRC). This committee will review the claims, which are rejected by the insurer.
Further, claim requests can only be rejected after approval of this committee. Also, insurers will have to give reason for rejection along with reference to the specific terms and conditions of the policy document.
No need to give document again and again
IRDAI has directed insurance companies or the Third-Party Administrators (TPAs) to collect the required documents directly from the hospital.
They cannot insist policyholders to submit these documents again to make a claim request.
