Listen to this article
With effect from October 1, 2024, health insurance policies have become more customer friendly.
Here are a few major developments in the health insurance regulations that can help you pitch health insurance policies more effectively.
Let us look at them.
Reduced waiting period
One important development is the revision in the waiting period of pre-existing conditions. IRDAI has reduced the waiting period of pre-existing conditions from 48 months to 36 months.
The insurance regulator said that all pre-existing conditions should be covered after 36 months irrespective of whether the policyholder has disclosed or not disclosed it. This means, health insurers cannot reject claims citing pre-existing conditions after 36 months.
Senior citizen friendly policies
IRDAI has done away with the maximum age limit for policyholders to buy a health plan. 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.
Wider scope of health insurance
IRDAI has directed health insurers to sell health policies to mental patients, special children, transgenders and persons infected with HIV or AIDS.
No claim can be denied after 5 years
IRDAI clarified that no claims can be denied after 5 years. According to the new norms, no policy or claim can be contested 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 5 years.
Meaningful discounts
If a client does not make 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.
Any time refund policy
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 a refund of Rs.6000.
Policyholders will have an option to discontinue the policy and get some refund whenever an insurer denies their claim request.
High chances of claim requests being settled
IRDAI has 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.
Better claim settlement experience
IRDAI has directed insurance companies and the Third-Party Administrators (TPAs) to collect the required documents directly from the hospital.
They cannot insist on the policyholders to submit these documents again to make a claim request.
Also, health insurers will have to come back on cashless claim requests within 1 hour. If the insurer is aggreging to settle cashless claim, the final payment has to be made within 3 hours of discharge.
