Healthier cover

Nov 19 2013, 08:05 IST
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SummaryThe new health insurance guidelines by Irda will make health cover claims much easier and establish a consumer-friendly system

disclose the maximum age up to which the renewal would be available in case the product is offered to specific age groups and the option available to migrate to other policies.

Also details of specific circumstances where premium could be loaded or discount withdrawn by the insurer will have to be mentioned in the policy document. If the insurer wants to withdraw a product, it will have to take Irdaís approval by citing reasons and complete details of how existing policyholders would be treated. Existing customers will have to be given an option to switch to a similar product.

All health insurance policies will have a free-look period of at least 15 days from the date of receipt of the documents to review the terms and conditions. If the policyholder has not made any claim during the free-look period and wants to return the policy, then a refund of the premium paid, minus any expenses incurred by the insurer on medical examination and stamp duty charges, would be made by the insurer. Also, in policies where the risk has already commenced and the policyholder wants to return the policy in the free-look period, then the insurer will deduct charges for the proportionate risk premium for the period of the cover. Also, in case of an unit-linked health insurance policy, in addition to the risk premium, medical examination and stamp duty charges, insurers will repurchase the units at the price of the units on the date of the return of the policy.

After receiving documents, the insurer will have to settle claims within 30 days. The insurance company will have to stipulate a time limit by which claims and documents should be furnished by the policyholder. And if there is any delay in the filing of documents, the insurers will not turn down the claims, unless the delay was deliberate.

To address the growing need of non-allopathic treatments, insurers will also have to cover alternative medicines, provided such treatment has been received at a government hospital or in any institute recognised by government.

All health insurance policies will allow access for treatment in hospitals across the country that arenít part of the network hospitals, except at unauthorised hospitals. Analysts say the new norms will enable the development of a robust consumer-friendly and reliable health insurance system in the country.

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