The Insurance Regulatory Development Authority of India, Irda has issued a circular to Chief Executive Officers (CEOs) of all General Insurance Companies to safeguard the interest of senior citizens who are the health insurance policyholders. Following are a few instructions which are binding to them.
- All health insurance products filed with Irda must allow entry at least till 65 years of age. If there is any difference in product specification for a different age group or different entry ages; it has to be clearly mentioned in the prospectus and policy documents.
- If any proposal for health insurance of senior citizen is denied then the grounds with reasons need to be mentioned in writing. Also such reasons should be justified and reasonable.
- Premium charged should be fair, justified, transparent and disclosed upfront. Even if there is any loading charge the policyholder should be well informed.
- Insurers should try to reward for early entry and for continued loyalty for renewals from the same insurer.
- Policyholders should be given an option to change their TPA (where TPAs are used by Insurers) which could be implemented 30 days prior to the renewal date of the policy and changed TPAs would be allocated by the insurer from amongst TPAs empanelled by the insurer for this purpose.
- Insurers could be penalized if there is any delay in issue of identity cards to policyholders beyond 30 days from issue of policy.
- All health insurance policies must have an annexure with the description of the coverage and key terms and conditions of the policy in simple language.
- Insurers will reimburse at least 50% of the cost incurred by the insured in pre-insurance medical examination, in cases where the risk is accepted. In addition, insurers will also enlist (or empanel, as the case may be) government medical institutions from which such pre-insurance reports will be accepted by them. Where the risk is accepted, copies of such medical examination reports should also be made available to the insured if requested for.
- Insurers will broadcast full information (like description of the product, copy of prospectus, proposal and policy clauses) of all health insurance products on their websites.
Provisions like these and few more mentioned in the Irda’s circular are applicable on all policies issued or renewed on or after 1st of July 2009. Failure to comply with any of these provisions would make the General Insurance Companies liable to appropriate action under the provisions of IRDA Act, 1999, the Insurance Act, 1938 and their regulations.
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