was hospitalised, and the hospitalisation claim has been admitted by the insurance company.
To make health insurance policies transparent, the insurer will have to mention details about the terms of renewal, coverage and the premium applicable as per the age progression of the policyholder. The insurer will also have to 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Also details of specific circumstances where premium could be loaded or discount withdrawn by the insurer will have to be mentioned in the policy document.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 Irda’s 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