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IRDAI directs insurers to periodically notify health insurance policyholders

In order to ensure flow of relevant information to policyholders, IRDAI has specified certain norms to be followed by insurers.

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Health insurance policyholders will now get a regular update and periodical notifications about their policy from the insurance company. While the policy document is forwarded with relevant information, in order to continue the relationship with policyholders and to ensure information flow, IRDAI now feels that it is important to periodically notify the policyholders certain relevant and key details relating to health insurance coverage available to the policyholders. IRDAI has asked the insurers to initiate the process at the earliest and not later than 1st June 2021.

Health insurance policies are typically an annual contract ( some are multi-year) between the policyholder and the insurance company. After buying health insurance policy on paying the premium, the insurer sends a policy document carrying the terms and conditions along with other documents such as premium receipts and tax certificate. IRDAI (Protection of Policyholders’ interests) Regulations, 2017 specifies the minimum information to be provided as part of health insurance policy.

In order to ensure flow of relevant information to policyholders the following norms are specified:

i) All the general and health insurers as part of policy servicing, shall communicate the following basic information about the health insurance policy to the policyholders:

a. Name of Product and policy number,

b. Extent of coverage available by way of available Sum Insured and Cumulative Bonus,

c. Number of insured people covered under policy,

d. Policy period,

e. Number and amount of claim settled (under relevant period), if any,

f. Balance Sum Insured and Accrued cumulative bonus available, if any,

g. Due date of renewal and premium payment frequency,

h. Premium amount due on renewal (to be specified at the time of renewal)

i. Grace Period (within 5 days after renewal due date)

j. Contact details (for any query or other issues) of customer support service of Insurer, Toll Free number or e-mail id etc.

The insurer may choose any mode of communication (message, e-mail, letter etc) for the purpose of notifying the information. So, make sure your email id is updated in the insurer’s records. These norms are applicable to all individual (both indemnity and benefit based) health insurance policies.

The information shall be communicated by insurers to all the policyholders twice in a year, i.e, 6 months after issuance of policy and at least 1 month prior to the renewal due date. However, in case of a multiyear policy, the information can be shared with a frequency of 6 months from the date of issuance of policy.

In addition to the above, in the event settlement of any claim under a health insurance policy, the insurer shall also communicate the details of balance sum insured along with the cumulative bonus available, if any, to the policyholder. This shall be notified to the policyholders within 15 days of settlement of claim.

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