The Insurance Regulatory Development Authority of India (IRDAI) has consolidated various guidelines on health insurance portability, renewal, and special provisions in health insurance for senior citizens. Post COVID-19 global pandemic outbreak, several measures have been taken by the Insurance Regulator to improvise the ecosystem of health insurance in India.
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These consolidated insurance guidelines were amended up to May 12, 2020, and here is what it shall cover:
Here is a quick rundown of these consolidated changes in detail below:
In the new guidelines, IRDAI proposes that the premium charged for both health insurance and life insurance products should be justified, duly disclosed upfront, and transparent. Senior citizens shall be allowed to buy the policy up to the age of 65 years. And any rejection of the proposal for medical insurance of a senior citizen should be in writing with reasons.
As per these guidelines if there is any balance claim or is not allowed under the previous mediclaim policy it can be made from other health plans if the sum insured of the previous policy is not exhausted. In such a case, the health insurance provider should settle the claim independently subjected to the terms and conditions of the other health plan.
The Health insurance renewal premium shall not be accepted more than 90 days in advance of the premium due date
Once the policyholder has paid the premium continuously for eight years, no look back to be applied. And this eight years period is termed as the moratorium period. It is applicable for the coverage amount of the first policy and subsequently, completion of 8 consecutive years would be applicable from the date the sum insured was increased that too only on the higher limits.
After the Moratorium Period is expired, no medical insurance claim is contestable unless it is a permanent exclusion or a proven fraud. However, all the deductibles, sub-limits, co-payments, shall apply as per the policy terms and conditions.
As per the guidelines mentioned in the circular, the insurance company shall not levy any additional charges particularly for porting a health insurance policy.
Health insurance companies shall offer coverage for one or more systems under AYUSH treatment cover as per the policy terms and IRDAI guidelines.
According to the IRDAI guidelines both the Health and General Insurance providers offering indemnity-based health insurance cover shall give the policyholders an option to switch to an alternative medical policy available at the time of policy withdrawal or modifications.
This is also applicable to specific indemnity plans for children under floater policies, specific age groups, students, etc. when they reach the exit age. The policy shall incorporate all the suitable credits that were maintained in the last policy. All the norms related to portability and migration of health plans issued by health and general insurance companies shall be subjected to IRDAI guidelines as issued from time to time.
According to the IRDAI guidelines, Health and General insurance companies should incentivize policyholders for continued renewals, early entry, preventive and wellness habits, and favourable claims experience.
The insurer would need to mention these incentives upfront in the policy documents and prospectus, in compliance with the Product Filing Procedure Guidelines.
Incentives for wellness and preventive habits should also be defined clearly in all the insurance products.
The policyholder shall be informed in writing about all the underwriting loading charges as filed and approved under the Product Filing Guidelines and the consent of the policyholder for such loadings should be obtained before the policy issuance.
In the likelihood of the policy being withdrawn in the future, the Insurer will have to intimate the policyholder about the same 90 days before the policy expiry date. At the time of renewal the policyholder will have the option to migrate to a similar medical insurance product available with the Insurer with all the accumulated continuity benefits such as waiver of the waiting period, cumulative bonus, etc. as per the IRDAI guidelines, provided there hasn’t been any break in the payment of the premium.
Health insurance companies now will endeavor to promote health and wellness among policyholders from time to time as per the new IRDAI guidelines as given in the circular.
This consolidated list is beneficial to both the insurers and the customers and will improvise the stance of the health insurance industry in the country, especially during the ongoing pandemic.
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