The Insurance Regulatory Development Authority of India has introduced new set of guidelines pertaining to the health insurance claim settlement. As per this the insurance company is liable to pay interest i.e. 2% above the bank rate to the policyholder for delay in claim payments. It is applicable from the date of receiving the last essential document to the date of claim payment.
*All savings are provided by the insurer as per the IRDAI approved insurance plan. Standard T&C Apply
*Tax benefit is subject to changes in tax laws. Standard T&C Apply
My name is
My number is
My name is
My number is
City Living in
Do you have an existing illness or medical history?
This helps us find plans that cover your condition and avoid claim rejection
What is your existing illness?
Select all that apply
When did you recover from Covid-19?
Some plans are available only after a certain time
This new amendment does not permit the Health insurance companies to contest claims if the policyholder has been paying premium continuously for a period of 8 years. The guidelines are issued in order to standardise and simplify the indemnity-based medical insurance terms and conditions. It is not applicable to personal accident and international and domestic travel insurance plans. The idea is to bring uniformity across the health insurance industry.
It further mentions that the health insurance contracts that are not in compliance with these new set of guidelines need to be modified when they are due for renewal on or before April 01, 2021.
As per the guidelines issued on Standardization of General Terms and Clauses in Health Insurance Policy Contracts, this duration of 8-years is also termed as the moratorium period, which would be applicable to the sum insured of the first health insurance plan. The moratorium of 8-years applies would be applicable from the sum insured enhancement date only on the enhanced limits.
After expiry of eight years of moratorium period the medical insurance claims are not contestable unless it is a fraudulent act or is mentioned under the policy exclusions. However, the co-payments, sub-limits, deductibles shall follow as per the Mediclaim policy contract.
Moreover, at the time of claim settlement, IRDAI instructs the insurers to reject or settle health insurance claims within 30 days on receiving the last essential document. And if the claim settlement is delayed, then the insurance company would be liable to pay interest to the insured at a rate of 2% above the bank rate. Any misinterpretation or non-disclosure by the policyholder would call for fortification of the premium paid and the policy will be cancelled.
And if the policyholder needs to port the policy as per the guidelines, he can do that and port it for all the family members and it needs to be done a minimum of 45 days before the renewal date. And if someone is insured under a health insurance policy at present and has been paying the premium continuously without any lapses, the proposed policyholder will get the accrued benefits of the waiting periods.
05 Jul 2022Barely any person has remained unaffected due to rising health...
05 Jul 2022Regular health check-ups are important to keep a track of your...
04 Jul 2022In India, healthcare is getting expensive with each passing day...
27 Jun 2022Gone are the days when only athletes and professional sports...
24 Jun 2022Healthcare is expensive in India and is increasing with each...