Page 58 - The Insurance Times March 2025

transfer the same to the bank account of the in- nel are required to be published on the respective
surer; insurer's website.
vii. If the proposal is rejected or if the prospect can- 4. As part of the ongoing monitoring of insurance prod-
cels the proposal, the insurer shall send an instruc- ucts offered in the Indian insurance market, it is ob-
tion to the partner bank to release the blocked served that there has been steep increase in premium
amount. The blocked amount is then unblocked by rates under some of the health insurance products of-
the prospect’s bank without any deduction; fered to senior citizens (aged 60 years and above).
viii. In any case, if the insurer does not process the ap- 5. The premium rate is primarily based on the estimated
plication within a period of 14 days, the blocked claims outgo and the expenses including acquisition
amount will be automatically unblocked through costs incurred by the insurance company for acquiring
the partner bank by the insurer. and servicing the insurance policies. The claims outgo
is largely dependent on the amounts charged by the
11. The insurers are allowed to use Bima-ASBA mechanism
for blocking of premium up to the limit specified by hospitals for various treatments / surgeries.
NPCI from time to time. 6. Unlike in case of Pradhan Mantri Jan Arogya Yojana
(PMJAY) scheme where the hospitalisation expenses are
12. At present, the facility of Bima-ASBA is extended to in-
negotiated centrally for package rates and are thus
dividual policyholders.
standardised across various hospitals, there is no such
13. All insurers shall go live and offer Bima-ASBA facility to standardisation in case of health insurance products.
the prospect or customer on or before 1st March 2025. This is leading to higher hospitalisation costs resulting
14. This has the approval of the Competent Authority. in higher claims outgo under health insurance products
offered by insurers.

AII Non-Life and Stand-Alone Health insurers 7.. In this context, the most vulnerable age group is the
senior citizens having limited sources of income and this
except AIC & ECGC
group is impacted the most when there is a steep in-
30th January, 2025 crease in health insurance premium. This matter has
been engaging the attention of IRDAI and is a regula-
Review of revision in premium rates under health insurance tory concern. Therefore, under the provisions of the
policies for senior citizens Section 14 of the Insurance Regulatory and Develop-
ment Authority Act, 1999 read with Section 34 of the
1. The IRDAI has undertaken a series of reforms in the
recent past reinforcing empowerment of policyholders Insurance Act, 1938, the IRDAI hereby directs all gen-
and bolstering inclusive health insurance, while enabling eral and health insurers, offering indemnity based indi-
vidual health insurance products to Senior Citizens, to
a conducive environment for ease of doing business for
promoting innovation and providing wider choice to the take the following steps, with immediate effect:
a) The insurers shall not revise the premium for se-
customers.
nior citizens by more than 10% per annum.
2. Measures taken in the interest of policyholders includes
mandatory time limits for approval of cashless claims, b) In the following cases, insurers shall undertake
prior consultation with the IRDAI:
mandating insurers to make available products / add-
a. If the increase proposed in the premium for
ons / riders to provide wider choice to the policyhold- senior citizens is more than 10% per annum.
ers / prospects catering to all ages; all types of medi-
cal, pre-existing diseases and chronic conditions; all sys- b. In case of withdrawal of individual health insur-
tem of medicines and treatments; all types of hospitals ance products offered to senior citizens.
and healthcare providers. The time period for consid- c) The insurers shall give wide publicity of the various
ering pre-existing disease and moratorium period is measures (including the above) taken for the ben-
reduced. efit of senior citizens while offering health insur-
3. Furthermore, for the benefit of senior citizens, the regu- ance products.
latory framework requires all insurers to establish a d) The insurer shall take necessary steps for common
separate channel to address their health insurance re- empanelment of hospitals and negotiate package
lated claims and grievances. The details of such chan- rates on the lines of PMJAY scheme.

52 March 2025 The Insurance Times