Changes Introduced by IRDAI With Regard to Health Insurance

Changes Introduced by IRDAI With Regard to Health Insurance

When a medical emergency occurs, the individual’s health becomes an issue of worry. In terms of financial assistance and emotional support, it can be equally overwhelming for both the patient and their loved ones. A health insurance company can offer financial support if the patient is covered with a complete policy. 

While purchasing health insurance is not mandated by law, a prospective policyholder has complete flexibility in selecting a plan. But how can a policyholder build confidence in an insurance company? Here is where the New Standardization Guidelines of the IRDA come into play. #

This article sheds light on IRDAI’s role in health insurance and how they regulate the insurance industry in India to guarantee fair practices in the business. #

IRDAI’s New Rules: Health Insurance Standardization Guidelines:

The IRDA’s 2020 health insurance standards emphasise claim settlement, the usage of several policies, etc. Consider the following new IRDAI regulations:

Claim Rejection: A health insurance company can only accept a claim if the health cover is renewed with a break for 8 years. The duration will be referred to as the moratorium period. Except for fraud and/or a claim brought against a policy exclusion after the moratorium period, the insurance company cannot appeal to the IRDAI against the settlement of a claim. A claim cannot be denied based on deception or nondisclosure. IRDAI has given the insurance firm eight years to check the information submitted by the policyholder; therefore, a claim cannot be denied on those grounds. * #

Include Telemedicine: The COVID-19 pandemic has compelled healthcare practitioners and individuals to offer and utilise telemedicine consultations. The charge for such online consultations can be substantial, resulting in a financial loss for the covered individual. Thus, IRDAI has requested that health insurance providers incorporate telemedicine coverage for different types of health insurance when applicable. This action has enabled physicians and patients to openly access medical opinions. * #

Claim Settlement: In case of a delay in claim settlement by the insurer, the insurer is obligated to pay interest on the claim amount at a rate of 2% above the bank rate. The claim should be settled within 30 to 45 days after the policyholder receives the final required paperwork. The timeframe will depend on the nature of the claim and the required investigation. *

Effective October 1, 2020, the guidelines, as mentioned above, will be applied to all health insurance policies filed. Regarding existing products, the terms and conditions will be amended for renewals after April 1, 2021, to comply with the rules.

Advantages for Health Insurance Policyholders: 

The IRDAI’s new health insurance regulations are not restricted to the insurance business but also to the policyholder. The policyholder must adhere to the following guidelines in the respective scenarios. #

  • Multiple Policy purchases: In the event of a claim, the insured may opt to file with a preferred insurance company, and the insurer will be responsible for paying the claim in accordance with the policy’s terms and conditions. In the case of numerous policies, the insured may file a claim for an amount denied by one insurer by filing a claim for the remaining amount with another insurer. This holds true if the amount insured under one policy is exhausted. *
  • Health Insurance Portability: If a policyholder is dissatisfied with the insurance company’s services, they have the option to switch to a similar plan from a different insurer. There are two possible situations regarding the portability of health insurance. First, switching to a new plan with the current insurance provider or switching to a new plan with a different insurance provider. *

* Standard T&C Apply

# Visit the official website of IRDAI for further details.

‘Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms, and conditions, please read the sales brochure/policy wording carefully before concluding a sale.‘

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