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There is good news for health insurance policy holders. The official body that regulates insurance services has made some changes in the rules, which will be very beneficial for the policy holders. Insurance regulator Insurance Regulatory and Development Authority of India (IRDAI) has come up with several reforms regarding health insurance protection cover. Its aim is to increase the service standards for the policyholder. Under the new rules, insurers will have to approve cashless claims within one hour and provide final authorization for discharge from the hospital within three hours. Not only this, it will also be necessary for insurance companies to give an additional one month's grace to the policyholder for the annual renewal of the health policy and also retain the benefits after the renewal of the insurance policy during this period of delay. IRDAI has sent a circular to the insurance companies regarding the amendment in these rules. Insurance companies will have to implement the new amendment with immediate effect. (With some exceptions). Notably, the new circular replaces the previous 55 circulars. Which strengthens the rights under health insurance.
New rules to know for health insurance holders
Insurance companies will have to approve cashless claims within one hour
The company will have to provide an additional one month's time to the policy holder for annual renewal of the health policy
The insurance company will also have to retain the post-renewal benefits of the insurance policy during the delay in renewal
The new rules also allow insurers to reward policyholders with no claims during the policy term with the option of offering an increased sum assured or a discounted premium amount.
Every insurance document must include a Customer Information Sheet (CIS). The insurance related things must be explained in very simple language. Like, what is the type of insurance?, what is the sum insured?, what are the coverage details?, what is not included?, what are the sub limits?, deductible amount? and how long will one have to wait?
Under the new rules, insurance companies will have to ensure immediate handover of the body at the time of death during treatment.
Insurance companies cannot cancel claims without the approval of the Claim Review Committee
Insurance companies and third party administrators must mandatorily collect documents from hospitals for settlement of claims; documents cannot be sought from policyholders.
People holding more than one health policy will be able to choose the policy under which they can claim the admissible amount, the primary insurer will have to settle the balance amount with other insurers.
Policyholders who wish to cancel the policy can get a refund of the premium for the unexpired policy
All individual health insurance policies are renewable and cannot be cancelled on the basis of previous claims except in cases of fraud, ambiguity or misrepresentation.
No fresh underwriting is required unless the sum insured increases
Under the new rules, insurance companies have been urged to offer 100 per cent cashless claim settlement and directed to empanel all categories of hospitals and healthcare institutions keeping in view the accessibility of different population segments.
A strict timeline has been imposed on portability requests through the Insurance Information Bureau of India (IIB) portal.