Know IRDAI New Standardization Guidelines for the Health Insurance

As the saying goes, a healthy mind resides in a healthy body. The health of every person is important and it can easily become a subject of concern whenever a medical emergency hits-in. A medical emergency can be drowning both for the patient and the family not just emotionally but financially even.

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    To take care of the finances part, having a health insurance plan will never leave in worries. Make sure that you have a comprehensive health insurance plan that will take care of the incurred medical expenses. The role of IRDAI is of vital importance when it comes to any insurance product and services.

    In this article let us understand the role of IRDAI in the health insurance sector and also highlight how it ensures fair practices in the business.

    First things first!

    What is IRDAI?

    It stands for the Insurance Regulatory and Development Authority of India. The primary intent of IRDAI was simply to optimize the Indian insurance sector and likewise provide new avenues for the development. In the year 1999, it was an autonomous body; however, in 2000 IRDAI became one statutory body that regulates the Indian insurance business.

    Undoubtedly, the trend in the insurance business changes at a fast pace. Right from the conventional way of buying insurance to taking the digital route IRDAI has kept up to date with the help of the standardization guidelines done from time to time. Let us understand IRDAI’s recent guidelines for the health insurance plans in 2020.

    What are the IRDAI Rules for Health Insurance Plans?

    The IRDAI has jotted down some key rules, which needs to be compiled with. Now, these rules will enable both the insurance company and the insured to avail the fair deal when it comes to a health insurance plan. Listed below are some of the key rules that are laid down by the IRDAI:

    • In case the policyholder of a health insurance plan renews the plan within the time that implies no gaps in the renewal then the plan will not have an exit age.
    • The group health insurance policy is only valid for up to one year.
    • The health insurance company should always inform about every detail related to the policy be it an individual health plan, a senior citizen health insurance plan, etc. The policyholder needs to be aware of the terms and conditions of the plan in regards to availing the treatment at medical centres across the nation.
    • For the certain health insurance plans, which provides coverage to a group of people let’s just say students or expecting woman, and so forth the health insurance company will provide an alternative to the policyholder wherein they can migrate to another plan when meeting the criteria of exit. Likewise, it also provides suitable credits when the policy has been renewed with no gaps.
    • In case the health insurance policy application has been denied, the insurance provider needs to come up with a transparent, fair and justifiable reason to the applicant in writing.
    • The policyholder who renews the plan timely bought the plan early or has a favourable claim experience with the health insurance provider will be rewarded. As approved by the board, the rewards need to be mentioned both on the policy document and prospectus.
    • The insurance provider needs to provide the list of all the medical facilities to the insured from where the report of medical need to be accepted by the provider before the policy is issued.
    • The premiums charged specifically for a senior citizen health insurance plan need to be fair and justifiable. The last sum needs to be communicated clearly to a potential policyholder.

    IRDAIs’ New Standardization Guidelines for a Health Insurance Plan

    The IRDAIs’ guidelines for the health insurance plans focus majorly upon the listed below aspects:

    • Claim Settlement: In case there is a delay in the claim settlement from the end of the health insurance company then the insurance provider needs to pay interest upon the claim sum at a rate of 2 per cent more than the rate of the bank. The claim needs to be settled within 30 days to 45 days right from the communicating date of the final required document to the insured. The time duration will then be upon the claim natures and the sort of required investigation.
    • Claim Rejection: The insurance company cannot reject a claim when the health insurance plan is renewed for a continuous eight years by the policyholder. This 8-year term is referred to as the moratorium period. Moreover, the insurance provider cannot appeal to the IRDAI against such a claim except for the claim or fraud that is raised against the exclusions of the plan after a moratorium period. The insurance provider can also not reject the claim on the premise of non-disclosure or misrepresentation. The IRDAI has given a term of 8-years to the insurance provider to verify the policyholders' information. Therefore, a claim on such grounds cannot be rejected.
    • Telemedicine within Health Insurance: This novel coronavirus pandemic has surely forced both the healthcare providers and the patients not just provide but also access the remote consultations. Therefore, the fees for such consultation online can prove to be on an expensive side that would turn to be loss in terms of finances to the insured person. The IRDAI has asked the health insurance providers to include the telemedicine in the coverage. With this move, the patients and medical practitioners are free to avail the medical opinions.

    The above-mentioned guidelines will remain applicable to the health insurance products that have been filed from 2020, October 1. As for the existing products, the terms and conditions will be modified complying with the rules upon the renewal after 2021, April 01.

    The Bottom Line

    In these tough times of COVID-19, it is highly advisable to buy the health insurance plan online. With a plethora of options available such as health insurance for parents, family, and so forth it is important to review the coverage and compare the features and of the plans offered by different health insurance companies in India.

    Your health is your priority. Everything else comes after it.

    Written By: PolicyBazaar - Updated: 30 July 2021

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