How IRDAI's new health insurance measures will help policyholders

Will IRDAI's updated health insurance regulations help policyholders?

Since the onset of the Covid-19 pandemic, the number of people opting for health insurance has  surged due to heightened awareness of health risks and the urgent need for protection against emergencies.

Despite this, health insurance penetration in India remains low, highlighting the need for simplicity, inclusivity, and accessibility. While the process of purchasing health insurance and navigating claims can be complex, the industry has continuously endeavoured to simplify insurance for consumers.

Challenges such as understanding complex jargon, comparing plans, understanding exclusions and nuances of riders are being actively addressed.

Efforts are being made to help individuals choose the right insurance, customise it as per their needs, deal with claim rejections due to pre-existing conditions, and comprehend the eligibility and claim processes more easily.

IRDAI measures to simplify, streamline health insurance

Recognising these challenges, the Insurance Regulatory and Development Authority of India (IRDAI) has issued new regulations that are designed to make health insurance more inclusive and user-friendly.

Accordingly, the IRDAI has mandated that insurance companies  must provide a broader range of options for policyholders, including domiciliary hospitalisation, outpatient treatment, day care,  home care,  cashless treatment, reimbursement options, and hospital stay.

Also read: Decoded: IRDAI's new health insurance rules on quick cashless approvals, higher penalties for non-compliance

More choices for policyholders

It is important to note that it is not mandatory for every insurance product to include coverage for all types of treatment. Instead, insurance companies are encouraged to create diverse products, add-ons, or riders tailored to meet the needs of different groups, such as senior citizens, children, and disabled individuals. This way, policyholders can select the coverage that best suits their specific needs.

Coverage  not contestable  after 60 months

The IRDAI has introduced a rule that enhances the long-term security of policyholders. After continuously holding a policy for five years (60 months), insurers cannot reject claims or deny renewal because of unintentional non-disclosure of pre-existing conditions.

This provision offers peace of mind, ensuring that minor oversight during the application process does not jeopardise coverage after five years. This relaxation, however, underscores the importance of honesty during the application process.

Also read: A mistake in filling up the hospital forms can cost you your insurance claims

Cashless authorisation in 1 hour

Imagine needing medical attention — the last thing you want to worry about is insurance delays. Now, IRDAI mandates insurance companies to respond to cashless authorisation requests within one hour and finalise discharge approvals within three hours. This translates to quicker access to treatment and less stress during a difficult time.

Free-look period

With the new regulations, policyholders have 30 days from the receipt of the policy document to review its terms and conditions. If they are not satisfied with any aspect of the policy, they can cancel it within this period. This option is available for policies with a term of one year or more.

Waiting period for pre-existing diseases

A major concern for many, including senior citizens, is the waiting period for pre-existing conditions. Following the IRDAI's recent decision, the waiting period for pre-existing conditions and specific diseases is now capped at a maximum of 36 months for all policyholders.

Premium instalments

The regulator has also extended the grace period for premium payments. If you pay monthly, you'll have an additional 15 days to settle your dues without your coverage lapsing. For quarterly, half-yearly, and annual payments, the grace period is a generous 30 days. It means you will be covered during the grace period, providing you with ample time to complete the payment.

Cancellation and portability

If a policyholder is dissatisfied with the services provided by their insurer, it is now easier to cancel the policy. The policyholder needs to give a written notice of only seven days to cancel, and the insurer is obligated to refund the proportionate premium for the unexpired policy period. This applies to policies with a minimum duration of one year, provided no claims have been made during the policy period.

Additionally, the policies for porting from one insurer to another have been simplified. The regulator now mandates a response time of five days on receiving a porting request. The acquiring insurer must communicate the proposal immediately, but no later than five days after receiving the information. Policyholders also have the right to transfer the sum insured, no-claim bonus, specific waiting periods for pre-existing diseases, and the moratorium period.

IRDAI's recent moves empower policyholders to prioritise their health without navigating unnecessary complexities, and offers peace of mind and financial security to policyholders.