Health policy holders rejoice: Regulator is on your side

The guidelines seek to address the problems of the health insurance sector which came into light in 2010 after four public sector insurers removed private hospitals from their preferred list citing over charging by them under the cashless scheme.

FP Staff June 01, 2012 11:56:00 IST
Health policy holders rejoice: Regulator is on your side

After its efforts to clean up life insurance, the Insurance Regulatory and Development Authority (IRDA) has now fixed its gaze upon the health insurance industry.

The insurance regulator released the draft guidelines by which it asked insurers to provide health policy to people up to 65 years of age.So far, insurers could deny cover to people over 60 as it was not mandatory. The move is likely to benefit India's senior citizens who have to incur huge medical bills because of the stringent health insurance rules. Besides, it has also proposed special provisions for senior citizens whose need for health care is pressing. Under the proposed norms, insurer will have to provide customers all relevant information to customers in a simple language in single page.

Secondly, Irda said there should not be an exit age for renewal, which earlier varied between 75 and 80 years. A DNA report says a lifetime renew ability of health insurance product may also be possible. "With some companies setting the renewability age to just 50-55 years on the basis of your past records, this will be a big breather.Irda also says in the draft that an insurance company cannot reject the renewal of a health insurance policy on the grounds that a policyholder made a claim in the previous years.

Health policy holders rejoice Regulator is on your side

Health insurance must be provided to people up to 65 years, and all mediclaim must be settled within a month.

Also policies will become hassle-free if premiums are regularly paid.

It also said life insurers shall offer products with policy term of at least 4 years and non-life insurers shall offer products for not more than 3 years.

The policy holder must also have access to treatment all over India in any hospital which is not even in the ambit of the network provider. IRDA has also suggested that insurers should at all times keep policyholders informed on nearest hospital where cashless facility is available. The insurers should also display the updated list of network providers on their websites. Moreover, Irda also accepts that non allopathic treatments will also be eligible for cover in government recognised hospitals.

Non-life insurers issuing policies will have to reimburse the policyholder 50 percent of the medical examination cost prior to providing a cover. If the policy is issued by a life insurer, it will have to bear the entire cost of the check-up.

The draft also talks about portability, under which a policy holder can migrate to another health insurance providing company, without losing any benefit.

If a holder has more than one health insurance policy, he will be free to decide who to settle a claim with.It is also thinking of properly defining the term "critical illness" so that people are not easily deprived of their claims.

In case of special policies, for example, those given to a student or maternity covers, the holders must be given the benefit to migrate to a more suitable policy once that term period is over. In doing so they must not lose the benefits of the earlier policy, Irda says.

It has also provided for issuance of travel insurance policies by companies on standalone basis. The insurers, it said, will also be allowed to come out with 'Health-plus Life Combi' products which would be a combination of life and health insurance cover.

There are currently over seven crore health insurance customers and their premiums add up to more than Rs 11,000 crore.

Insurance companies might not be amused at the guidelines, but is implemented, it will surely make life easier for the policy holders.

Highlights of the IRDA guidelines:

• Life Insurers to offer Products with policy term of 4 years

• Non-life to offer products for 3 years

• Health insurance policies to allow treatment across pan-India

• Travel insurance can be offered as standalone product

• Policy holders to have option to migrate to a suitable health insurance policy

• Special provisions for insured senior citizens

• Life & non-life cos can launch 'Combi Products'

• Claim can be settled within 30 days

You can read the draft regulations here.

Wtih inputs from PTI

Updated Date:

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