Irda?s exposure draft not only calls for making health insurance affordable for the elderly, but also paves the way for a better experience for all customers
From now on, one can take a health insurance policy till the age of 65. Also, the policy will not have an exit age for renewal once the proposal is accepted, provided it is continuously renewed without break. Moreover, any loading charge or rise in premium should be spelt out in detail at the time of issuing the policy.
The Insurance Regulatory and Development Authority (Irda) has come out with an exposure draft on health insurance and experts say if the recommendations are implemented, it will benefit customers, especially those in the older age bracket.
However, they are not too sure on the pricing of the policy for the elders.
The regulator has said that all health insurance policies shall allow access for treatment in network provider or in any hospital which is not part of the network provider across the country. The insurer will have to explicitly state all the terms and conditions of treatment across the country in the policy document. Customers will also have the option to use the bonuses accrued by way of lower premiums of the higher sum insured and, in case of claims, the sum assured should come down in a pro-rated manner. As a free-look period, the customer will have 15 days after the issuance of the policy to decide whether to take the plan.
The regulator has also specified that any differences in product specifications for different age groups or for different entry ages must be clearly disclosed upfront in prospectus and policy documents. The insurer shall not compel the insured to migrate to other health insurance products. The insurer cannot compel the insured to migrate to other health insurance products, if it is to the disadvantage of the insured.
Insurers will have to ensure adequate dissemination of product information on their websites, which will include description of the product, copies of the prospectus, proposal form, policy clauses and premium rates inclusive and exclusive of service tax, as applicable.
Insurers will have to settle claims within 30 days of the receipt of complete documents and would have to stipulate a time limit by which the claims and documents should be furnished by the insured. If there is any delay in the filing of documents by the insured, the insurers will not deny such claims unless the delay was deliberate.
The insurers will have to devise mechanisms to reward policyholders for early entry and continued renewals and disclose the same upfront in prospectus and policy document. For cost of pre-insurance health check-up in case of non-life insurers, where the proposal is accepted and, subsequently, resulted in a policy, the insurers will have to reimburse at least 50% of the cost incurred by the insured in pre-insurance medical examination.
In case of life insurers, where the proposal is accepted and, subsequently, resulted in a policy, the insurers shall incur the costs and may suitably allow such costs incurred by the insured in pre-insurance medical examination within the premium levied to the policyholder.
Insurers will have to empanel government medical institutions from which pre-insurance medical examination is to be done. Policyholders having multiple health insurance policies can claim from multiple insurers, if the benefits covered are fixed in nature and the contributory clause shall not be applicable in this case.
For senior citizens, the premium charged for health insurance products will have to be fair, justified, transparent and disclosed upfront and any loading charged on the premium will have to be informed. Health insurers and third-party administrators will have to address a separate channel to address the health insurance-related claims and grievances of senior citizens.
The regulator has said that for loading on renewals, if the individual claims experience, for each of the three consecutive policy years other than the current policy year, is more than 500% of the premium under the current policy, the insurer at the time of renewal may load the premium as per the pre-determined table, disclosed at the outset in the prospectus and the policy document.
Insurers will also have to provide coverage to non-allopathic treatments, provided the treatment has been undergone in a government hospital or in any institute recognized by government and/or accredited by Quality Council of India/National Accreditation Board on Health or any other suitable institutions.
If the insurer wants to withdraw a particular product from the market, it will have to take the approval of Irda by giving reasons and complete details of the treatment to the existing policyholders. Existing customers will have to be given an option to switch to a similar product.
A policyholder who wants to port his policy to another insurance company will have to apply to the insurance company at least 45 days before the premium renewal date of his existing policy. The insurer may not be liable to offer portability if policyholder fails to approach the new insurer at least 45 days before the premium renewal date.
Key proposals
* Now, you can take a health insurance policy till the age of 65 years
* The policy will not have an exit age for renewal once the proposal is accepted, provided the policy is continuously renewed without break
* The insurer will have to explicitly state all the terms and conditions of treatment across the country in the policy document
* Any differences in product specifications for different age groups or for different entry ages must be clearly disclosed up front in prospectus
* The insurer cannot compel the insured to migrate to other health insurance products, if it is to the disadvantage of the insured
* For senior citizens, the premium charged for health insurance products will have to be fair, justified & transparent
