MUMBAI: Insurance regulator Irdai has introduced several reforms in the health insurance sector aimed at improving service standards for policyholders. The new norms require insurers to approve cashless claims within one hour and give final approval for hospital discharge within three hours.
In addition, insurers must provide a one-month grace period for the annual renewal of health insurance policies and protect benefits from policies renewed within that period.
Irdai has issued a circular on health insurance products, which comes into effect immediately (subject to certain exceptions). The new circular, which repeals 55 earlier circulars, consolidates claims into one health insurance policy.
Under the new norms, insurers will have to ensure that in case of death during treatment, hospitals release mortal remains promptly. Companies cannot reject a claim without the approval of a claims assessment committee. For claim settlement, insurers and TPAs (third party administrators) will have to obtain documentation from hospitals and cannot ask for it from the insured. Policyholders with multiple health insurance policies can choose the policy under which they claim the permissible amount. The primary insurer will coordinate with other insurers for the settlement of the balance. The new rules will allow insurers to reward policyholders who do not make claims during the policy term by offering either a higher sum assured or reduced premium amounts.
Policyholders who wish to cancel their policy can receive a refund of the premium for the remaining period. All individual health insurance policies are renewable and cannot be rejected based on previous claims, except in cases of fraud, concealment or misrepresentation. No new underwriting is required unless the sum insured increases.
Under the new norms, insurers have been asked to make claim settlement 100% cashless and include all categories of hospitals and healthcare providers in the list, keeping in mind affordability for different sections of the population. There are stricter timelines for portability applications through the Insurance Information Bureau of India (IIB) portal.
In addition, insurers must provide a one-month grace period for the annual renewal of health insurance policies and protect benefits from policies renewed within that period.
Expand
Irdai has issued a circular on health insurance products, which comes into effect immediately (subject to certain exceptions). The new circular, which repeals 55 earlier circulars, consolidates claims into one health insurance policy.
Under the new norms, insurers will have to ensure that in case of death during treatment, hospitals release mortal remains promptly. Companies cannot reject a claim without the approval of a claims assessment committee. For claim settlement, insurers and TPAs (third party administrators) will have to obtain documentation from hospitals and cannot ask for it from the insured. Policyholders with multiple health insurance policies can choose the policy under which they claim the permissible amount. The primary insurer will coordinate with other insurers for the settlement of the balance. The new rules will allow insurers to reward policyholders who do not make claims during the policy term by offering either a higher sum assured or reduced premium amounts.
Policyholders who wish to cancel their policy can receive a refund of the premium for the remaining period. All individual health insurance policies are renewable and cannot be rejected based on previous claims, except in cases of fraud, concealment or misrepresentation. No new underwriting is required unless the sum insured increases.
Under the new norms, insurers have been asked to make claim settlement 100% cashless and include all categories of hospitals and healthcare providers in the list, keeping in mind affordability for different sections of the population. There are stricter timelines for portability applications through the Insurance Information Bureau of India (IIB) portal.
“Incurable gamer. Infuriatingly humble coffee specialist. Professional music advocate.”
