IRDAI Consolidates Changes in Health Insurance Rules

The Insurance Regulatory and Development Authority of India (IRDAI) has issued compiled health insurance regulations of the amendments made in the last few months.

The consolidated guidelines focus on standardizing rules for insurers and making the entire ecosystem consumer-centric. This comes especially when the country is observing a lockdown and people are becoming more aware of the need to have an insurance policy after the Coronavirus outbreak.

“The guidelines mention incentives by insurers to reward policyholders for early entry, continued renewals (wherever applicable), favourable claims experience, preventive and wellness habits. They also specify that an insurer shall not deny the renewal of a health insurance policy on the ground that the insured had made a claim or claims in the preceding policy years,” says Amit Chhabra, Head of Health Insurance, Policybazaar.com.

1. Underwriting: IRDAI has specified that general and health insurers may devise mechanism or incentives to reward policyholders for those who buy one at a younger age, continued renewals (wherever applicable), favourable claims experience, preventive and wellness habits and disclose upfront such mechanism or incentives in the prospectus and the policy document.

2. Designing of health insurance policies: All insurers should provide a standard health insurance product to enable access to the basic health insurance covers.

3. Renewal of health insurance policies issued by General insurers and health insurers: The insurer shall provide for a mechanism to accept a delay in renewal up to 30 days from the due date of renewal without deeming such condonation as a break in policy. However, coverage need not be available for such a period. Provided the renewal premium shall not be accepted more than 90 days in advance of the due date of the premium payment.

4. Migration of health insurance policy: General insurers and health insurers offering indemnity based health covers shall offer an option to the policyholders to migrate to a suitable alternative health insurance policy available at the time of modification or withdrawal of the policy.

5. Ayush coverage: All insurers may endeavour to provide coverage for one or more systems covered under ‘AYUSH treatment’ provided, the treatment has been undergone in the hospitals or health-care facilities subject to the guidelines as may be specified by the Authority from time to time.

6. Wellness and preventive aspects: Insurers may endeavour promoting wellness amongst policyholders of health insurance as per the guidelines as may be specified by the Authority from time to time.

7. Special provisions for senior citizens: The premium charged for health insurance products offered by Life Insurers, General Insurers and Health Insurers to senior citizens shall be fair, justified, transparent and duly disclosed upfront.

8. Multiple policies: If two or more policies are taken by an insured during a period from one or more insurers to indemnify treatment costs, the policyholder shall have the right to require a settlement of his/her claim in terms of any of his/her policies. Balance claim or claims disallowed under the earlier chosen policy/policies may be made from the other policy/policies even if the sum insured is not exhausted in the earlier chosen policy/policies. The insurer(s) in such cases shall independently settle the claim subject to the terms and conditions of other policy/policies so chosen.

9. Administration of health policies: Subject to the terms and conditions of the policy contract, reimbursement shall be allowed at any hospital or medical establishment. All such establishments must be licensed or registered as may be required by any Local, State or National Law as applicable.

10. Portability of health insurance policies: In order to accept a policy which is being ported in, the insurer shall not levy any additional charges exclusively for the purpose of porting.