Page 49 - The Insurance Times July 2020

CIR/150/07/2016) dated 29th July, 2016. Sanjeevani Policy” after filing the same on Certification
xiii) Short term health insurance products shall be filed Basis as referred to at Para (3) aboveand on getting the
as per Chapter III (File and Use Procedure) of UIN from the Authority. The use of the name “Arogya
Sanjeevani” and the “Use and File” procedure are
Guidelines on Product Filing in Health Insurance
Business (Ref: IRDA/HLT/REG/CIR/150/07/2016) permitted only if the standard terms and conditions of
dated 29th July, 2016 and shall be launched only “Arogya Sanjeevani’ product are followed.
after prior approval of the Authority. 5. This will come into force with immediate effect.
5. These guidelines will remain valid for issue of short term 6. This has approval of the competent Authority.
policies till 31st March, 2021 unless extended further.
6. These guidelines are issued under the powers vested in D V S Ramesh,
Section 34 (1) of Insurance Act, 1938. General Manager (Health)
7. This has the approval of the competent authority.
Provision of cashless facility to the
(D V S Ramesh) policyholders
General Manager (Health)
IRDAI/HLT/MISC/CIR/189/07/2020
Guidelines on Standard Individual Date:14-07-2020

Health Insurance Product 1. It has been brought to the notice of authority that
certain hospitals are denying cashless facility to
IRDAI/HLT/REG/CIR/172/07/2020
policyholders for treatment of covid-19.
Date:07-07-2020
2. Attention is drawn to the provisions of regulation 31 (d)
of IRDAI (Health insurance) Regulations, 2016 wherein
1. Attention is drawn to Clause 7 of Section C of Guidelines
every general and health insurance company shall
on Standard Individual Health Insurance Product (Ref:
endeavour to enter into agreements with adequate
IRDAI/HLT/REG/CIR/001/01/2020 dated 01.01.2020)
number of both public and private sector network
wherein General and Health insurers are allowed to
providers across the geographical spread.
offer Sum Insured options ranging from minimum
3. Further, in terms of Regulation 31 (a) of IRDAI (Health
Rs.1,00,000/- to maximum of Rs.5,00,000/- (in the
multiples of 50,000/-)for “Arogya Sanjeevani Policy”. Insurance) Regulations, 2016, general and health
insurance companies may offer policies providing
2. Whereas the standard policy is required to be offered
cashless services to the policyholders. For the purpose
by all General and Health insurers for sum insured of providing cashless services insurers / Third Party
between Rs.1 lakh and Rs.5 lakhs, to further facilitate Administrators (TPAs) shall enlist network providers
the general public, insurers are hereby allowed to offer (hospitals) to provide medical services and shall also
minimum sum insured less than Rs.1,00,000/- and enter in to a service level agreement.
maximum sum insured greater than Rs.5,00,000/-
4. In this regard, insurance companies are advised to
subject to the underwriting policy of the Insurers.The
ensure that where the policyholder is notified about
Sum insured options shall be offered in the multiples of
availability of cashless facility at the empanelled
Rs. 50,000/-(fifty thousand) only.
network provider, the cashless facility at such network
3. The tables of premium rates for revised sum assured provider shall be made available to the policyholder in
slabs shall be filed in terms of Clause C (10) of accordance to the terms and conditions of the policy
“Guidelines on Filing of Minor Modifications in the contract and as per the terms agreed in Service Level
approved Individual Insurance Products offered by Agreement (SLA).
General and Stand Alone Health Insurers on
5. Insurance companies are also advised to put in place
Certification Basis” (Ref No: IRDA/HLT/CIR/MISC/151/
an exclusive grievance redressal mechanism to address
09/2019 dated 20th September, 2019).
the grievances of policyholders relating to the denial of
4. Insurers may launch the modified version of the “Arogya cashless facility for covid-19 and other grievances

The Insurance Times, July 2020 49