The Insurance Regulatory and Development Authority of India (Irdai) has recently introduced five major changes to health insurance regulations to make policies more customer-friendly. We take a look.
Policies To Become More Senior Citizen Friendly
Health insurance is crucial for senior citizens as they are more prone to illnesses. Some recent changes make it easier for seniors to get health insurance.
Now, one can buy insurance policies regardless of age. Earlier one could buy an insurance policy only till the age of 65. What’s more, the Irdai has also asked insurers to create policies designed to meet the needs of senior citizens. Insurers have also been asked to set up separate channels to address the grievances of seniors.
Claims Cannot Be Denied After Five Years
Another important change is that insurers cannot deny claims after five years of the policy being in force on the grounds of misrepresentation and non-disclosure. A policy claim can be contested only if fraud is discovered.
More Power To Policyholders When It Comes To No -Claim-Bonus And Refunds
If a policyholder does not make any claims during the year, their sum assured goes up from the next year. However, policyholders have the option of either increasing their sum assured or decreasing their premiums in the coming year.
Policyholders can also discontinue their policy at any time and receive refunds on a pro-rata basis. For example, if the premium for a year is Rs 15,000 and one discontinues the policy after six months, one can get a refund of Rs 7.500.
Also, if an insurer denies a claim, a policyholder can discontinue the policy and get a refund on the unused premium.
Harder To Reject Claims
Insurers need to set up a claims review committee to review rejected claims. Also, a claim can be rejected only after the approval of the committee and specific reasons for the rejection should be provided with reference to terms and conditions of the policy. This is likely to mean that claims will not be rejected without a valid reason.
Simplified Documentation Process
Insurance companies have been mandated to collect necessary documents directly from the hospitals. This would mean that the insured does not need to submit the documents multiple times when making a claim.
These changes are meant to make health insurance policies more friendly to policyholders, especially senior citizens. This is expected to improve the overall experience for policyholders and also make health insurance more accessible to everyone.
