IRDA lays out guidelines on health insurance

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In order to strengthen the health insurance industry, the Insurance Regulatory and Development Authority (IRDA) has issued terms and conditions for health insurance such as entry age, claim settlement period and specific reasons for denial of claim.

The draft points out that companies will have to provide health insurance for up to 65 years and that it should be renewed for life once it is accepted and premium is paid regularly. Life insurers can offer products with four-year term while non-life companies can offer up to three years. The regulator has asked all stakeholders to give their feedback by June 30.
In the exposure draft, the regulator has asked insurers to reimburse at least 50% of cost incurred by the insured in pre-insurance medical examination, if the policy is accepted.
IRDA has proposed to establish a separate channel to address health insurance-related claims and grievances of senior citizens.
Insurers are allowed to provide coverage to non-allopathic treatment provided the treatment is done at a government hospital or in any institute recognised by government. Also, the regulator has specified that all policies offering critical illness should have standard definitions.
Companies will have to offer a new product before withdrawing a plan. IRDA has asked insurers to file an uncomplicated one page customer info sheet in simple language. The regulator has discouraged companies from asking the insured to shift to another plan. If a claim has to be rejected, the insurer will have to do it within 30 days giving reasons for denial.


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