Page 48 - Insurance Times July 2024

FEATURE

IRDAI overhauls health cover norms to

empower policyholders

I n a move to empower policyholders and bolster In the event of no claims during the policy period, the

inclusive health insurance, the Insurance Regulatory
insurers may reward the policyholders by providing an option
and Development Authority of India (IRDAI) has
to choose a No Claim Bonus, either by increasing the sum
announced major revamp of regulatory norms.
Policyholder to get a refund of the premium/ proportionate
The regulator has issued a comprehensive Master Circular insured or discounting the premium amount.
on Health Insurance Products, repealing 55 circulars. premium for the unexpired policy period if he chooses to
The circular gives operational affect to a slew of regulatory cancel his/her policy at any time during the policy term.
changes announced by IRDAI last month in health coverage, Advantages
including the removal of the upper cap on age and brings in A health insurance policy is renewable and shall not be denied
new features such as a customer information sheet to provide on the ground that the claim(s) were made in the preceding
transparency and the option to distribute claim amounts from policy years, except in cases of established fraud or non-
multiple policies one may have from different companies.
disclosure, or misrepresentation by the insured, IRDAI said.
All the entitlements in a health insurance policy available Policyholders will gain significantly in the wake of new
to a policyholder have been brought into one place in the norms, according to industry experts. According to Sharad
Master Circular. Mathur, Managing Director & Chief Executive Officer of
The repeal of previous circulars has been done to provide Universal Sompo General Insurance, the master circular
for new norms and to make a single-point reference on the issued by IRDAI "will simplify the insurance buying and
total norms for policyholders as well as insurers servicing process even further.''
Affordability "Newly introduced measures such as the processing of cashless
authorisation requests within one hour, the freedom to choose
It also emphasised measures towards providing a seamless,
faster, and hassle-free claims experience and ensuring treatment of choice, including Ayush-certified therapies, and
the choice of adjusting the No Claim Bonus by discounting future
enhanced service standards across the health insurance premiums or increasing the sum assured are bound to delight
sector. The major norms spelt out by IRDAI include a wider existing policyholders,'' he added.
choice for the policyholders by offering diverse insurance
products catering to all ages, regions, occupational Anuj Parekh, co-founder and CEO of Bharatsure, said the
categories, medical conditions/treatments, and all types of norm for insurers to provide cashless authorisation within
hospitals and health care providers. one hour and final authorisation within 3 hours of intimation
by the hospital will make the process more efficient and can
This is aimed at providing suitability and affordability. significantly improve the customer experience for the
Insurers will also need to provide a Customer Information patient and their family members.
Sheet (CIS) with every policy document. Customers are also
to be provided with the flexibility to choose products, add- Narendra Bharindwal, Vice-President of the Insurance
ons, or riders as per their medical conditions/specific needs. Brokers Association of India (IBAI), said the Master Circular
outlines several key points for health insurance policyholders
A policyholder with multiple health insurance policies gets and insurers, such as the right to a policyholder to seek a
to choose the policy under which he/she can get the refund of premiums for the unexpired policy period if they
admissible claim amount. cancel their policy early.
"The primary insurer with whom the claim is first submitted "The aim is to achieve 100 per cent cashless claim
should co-ordinate and facilitate settlement of the balance settlements and streamline the health insurance process,"
amount from the other insurers," IRDAI said. he added. (BusinessLine)

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