Page 44 - Insurance Times September 2021

5. Credit for investment income - Non-cooperation by the proposer
6. Profit margin - Pre-acceptance medical check up for all insured
persons entering the policy age of 60 years.
Retail Insurance is a class rated product and will be governed
by the internal underwriting guidelines of each company and - Pre-acceptance health check-up persons up to 60
also rates as filed with and approved by IRDA. years of age with advance medical history ( fresh
1. Renewal of individual mediclaim policy cannot be denied entrants) or break in insurance.
other than cases/proposals with fraud, - Last claim details
misrepresentation, non-disclosure of material facts. If - Consume Tobacco detail
at the time of claim, any of above is discovered, the - Good health declaration
policy will be cancelled after due notice giving 15 days'
- Psychiatric disorder
time to insured.
- Genetic disorders
2. No loading shall be applied on claims of expiring policy as
per IRDA Health Insurance Regulations 2016. - Any person aged between 18 years and 65 years
can take Mediclaim policy (may differ company to
3. Retail product should cover all section of insured persons,
company)
Senior citizens, women, minor children, physically
disabled persons, HIV/AIDS contracted person etc. - Nomination (mandatory) - For individual policy
holder. It is mandatory to make a nomination by the
4. The underwriting parameters for risk acceptance will proposer for the purpose of claim payment in the
include age, pre-existing conditions, past claim history, event of death of insured.
good health practices and such other relevant
parameters of proposer like occupation, married or - All policies to be serviced by TPA (for PSU). Choice of
single, food habits etc. TPA as per IRDA guidelines for individual Mediclaim
policy.
5. Portability: - For retail policies from one insurer to
another insurer. Portability procedure as per IRDA - Empanelment of preferred provider network
guidelines. No intermediator charges are payable. hospitals. In case of PSUs cashless is made available
in these network hospitals. In all other non-network
6. Free look period: - Applicable for retail policies. Insured hospitals, the claims are honoured by way of re-
will be allowed a period of at least 15 days from date of
imbursement claims.
receipt of policy to review terms and conditions of the
policy and to return the same if not acceptable. This Rejection - Insurance is a subject matter of solicitation.
Insurer has the right to decide to accept or reject the
condition is applicable for insured persons taking policy
proposal based on objective criteria. In accordance
first time.
with IRDA health regulations 2016, a denial of
7. 30 days grace period: - If the insured failed to remit proposal shall be communicated to prospect in writing
premium for renewal before expiry of the period of by recording the reasons of denial.
insurance but within 30 days thereafter. Admissibility of
any claim during the period of subsequent policy shall be - Premium payable annually. There is a provision of
no claim discount of 5% after every claim free year
considered in the same manner as under a policy renewed
and maximum up to 15%.
without break. But company will not be liable for claims
made in the interim period of 30 days. - Underwriting looking for pre-existing conditions. A
risk loading on the premium payable depending upon
8. Acceptance or denial of proposal: - The basis of insured health status. Loading not be more than 50%
acceptance of proposal /renewal will be as per internal of premium.
underwriting of the company which includes
- Age - Underwriter may seek re-insurance support in
respect of major group health policies and
- Pre - existing health conditions
government scheme to:
- Family health history Y Obtain technical expertise on pricing & designing of
- Moral Hazard product.
- Misrepresentation, fraud, non-disclosure of material Y Introduction of various loss control measures under
facts group policies.

44 The Insurance Times, September 2021