IRDAI Announces Reforms in Health Insurance
Updated On: 30 May 2024
The Insurance Regulatory and Development Authority of India (IRDAI) has taken a significant step towards empowering policyholders and promoting inclusive health insurance with its new Master Circular on Health Insurance Products dated 29.05.2024
Key Highlights for Policyholders:
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Diverse Product Offerings: Insurers must provide a wide range of products, add-ons, and riders catering to various ages, regions, occupations, and medical conditions, ensuring affordability and suitability for all policyholders.
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Customer Information Sheet (CIS): Simplifies insurance details, including coverage, exclusions, deductibles, and waiting periods, for easy understanding.
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Flexible Choices: Policyholders can select products and riders based on specific medical needs.
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Multiple Policy Claims: Allows choosing which policy to claim from, with coordination from the primary insurer for any balance amount.
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No Claim Bonus Options: Rewards for no claims can be in the form of increased sum insured or premium discounts.
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Premium Refunds: Pro-rata premium refunds available for policy cancellations.
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Guaranteed Renewability: Policies are renewable without new underwriting, except in cases of fraud or misrepresentation.
Compliance for Insurers:
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Technology Integration: Insurers must provide seamless onboarding, renewals, and policy servicing with end-to-end technology solutions.
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Cashless Claims: Aim for 100% cashless claim settlements promptly.
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Hospital Empanelment: Include diverse healthcare providers to ensure affordability.
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Transparency on Website: Display hospital networks, claim procedures, and timelines.
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Quick Claim Processing: Immediate decisions on cashless requests and swift final authorizations on hospital discharge.
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Claims Review Committee: No claim repudiations without committee approval.
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Document Collection: Insurers and TPAs must collect required documents directly from hospitals.
Additional Provisions:
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Portability Requests: Stricter timelines for handling portability requests.
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Ombudsman Awards: Insurers must implement awards within 30 days or pay Rs. 5000 per day.
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AYUSH Treatment: Equal treatment options for AYUSH therapies.
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TPA Performance: Regular monitoring and payment based on satisfactory service.
The detailed Master Circular is placed at IRDAI website at https://irdai.gov.in/web/guest/document-detail?documentId=4942918