New lease of life

Feb 12 2013, 09:26 IST
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SummaryThe Insurance Regulatory and Development Authority finally approved the health insurance regulations last week and these will come into force from the date of publication in the official gazette.

With Irda approving health insurance regulations, policyholders can expect transparency and fairer treatment from insurers

The Insurance Regulatory and Development Authority (Irda) finally approved the health insurance regulations last week and these will come into force from the date of publication in the official gazette.

All health insurance policies will now provide for entry age up to 65 years and will not have any exit age for renewal once the proposal is accepted, provided the policy is continuously renewed without break. Insurance companies will not be allowed to load charges on an individual medical insurance policy that is being renewed, even if the policyholder has made a claim.

Life insurers selling health insurance policies will offer products with a policy term of at least four years and non-life insurers will offer products for not more than three years. All products offered as group policies, either by life or non-life insurers, will offer only one-year renewable group health insurance policies.

All health insurance policies will allow access for treatment in the network provider or in any hospital, which is not part of the network provider, across the country, except in unauthorised hospitals excluded from providing healthcare services for health insurance policies.

Irda hopes the regulations will enable the development of a more robust, consumer-friendly and reliable health insurance system in the country.

Analysts say once the regulations come into force, insurers will have to tweak their products and policyholders will know the terms and conditions of various treatment as the insurers will have to explicitly state in the policy document all the terms and conditions with respect to availability and availing of treatment across the country.

Also, if different terms are offered for availing treatment across the country, they will have to be stated explicitly in all the promotional material and will have suitable provisions built in the proposal form.

For senior citizens, the premium charged for health insurance products will have to be fair, justified, transparent and disclosed upfront; and any loading charged on the premium will have to be intimated. Health insurers and third-party administrators will have to pursue a separate channel to address health insurance-related claims and grievances of senior citizens.

Insurers will also offer a cumulative bonus, which will be stated explicitly in the prospectus and even in the policy document.

Moreover, insurers cannot compel the insured to migrate to other health insurance products if they don’t suit

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