Page 49 - Insurance Times July 2024

FEATURE

Moratorium reduced for health policy

but full disclosure crucial

T he Insurance Regulatory and Development Prospective customers should not turn complacent. "While
Authority of India (IRDAI) issued a master circular
purchasing a policy, declare your medical history, current
health status, and life style habits (like smoking)
on health insurance on May 29, 2024, listing 20
provisions. These norms, if properly implemented,
health insurance, Policybazaar.com.
will make health insurance simpler, more accessible, and a comprehensively," says Siddharth Singhal, business head-
reliable instrument for protecting customers' interests.
Cashless approval within an hour
"The master circular encourages insurers to adopt customer- The regulator wants insurers to achieve 100 per cent
centric policies. This can positively impact insurance cashless claim settlement and minimise settlement through
penetration. It will lead to a UPI-like movement-deeper
reimbursement. The request for cashless authorisation must
penetration and higher adoption-within the health insurance be decided immediately or within one hour.
ecosystem," says Prakash, managing director/chief executive
officer designate, Galaxy Health and Allied Insurance.
Insurers must set up help-desks at hospitals and provide pre-
authorisation via digital modes. They must put the necessary
Proportionate refund of premiums systems in place by July 31, 2024.
Previously, if a customer purchased a health insurance policy
and decided to discontinue it during the policy term, she "The regulator's emphasis on shifting 100 per cent claims to
would receive a refund based on a 'short-premium scale'. cashless settlement will ease policyholders' financial burden,"
For example, if she had used the policy for three months, says Naval Goel, chief executive officer (CEO), PolicyX.
the insurer would deduct six months of premium. If she had
used it for six months, the insurer would deduct nine months' Cashless treatment is available only at network hospitals.
premium, and so on. "Verify if your preferred hospitals are in the insurer's network
and understand the cashless claim process to avoid last-
Now, after the free-look period of 30 days, a customer can minute issues," says Pooja Yada, chief product officer, Zuno
cancel the policy with a seven-day notice and get a General Insurance.
proportionate premium back, unless she has made a claim.
"The insurer will only deduct the premium for the period Discharge within three hours
for which the policy was used. This change provides greater Patients have often been held up at the hospital for hours
flexibility to people who wish to discontinue their policy," after discharge because the insurer had not settled their bill.
says Kapil Mehta, cofounder, SecureNow. Some have incurred additional costs for spending and extra
night at the hospital. The regulator has mandated that if
Reduction in moratorium period there is any delay beyond three hours, the insurer must bear
The moratorium period has been reduced from eight years the additional cost. "In the future, if there is any delay from
to five. Previously, after eight years, an insurer could not the insurer's side, do not pay the additional waiting
deny a claim except in case of an established fraud. charges," says Goel.

Coverage for high-tech treatments
"This means claim payment will become assured sooner,"
says Mehta. The regulator has urged insurers to cover high-tech

44 July 2024 The Insurance Times