Business Desk, ETV Bharat: In what will make health insurance policies more customer-friendly and inclusive, the new guidelines issued by the Insurance Regulatory and Development Authority of India (IRDAI) will come into effect from 1 October 2020, changing the way insurers sell policies and settle claims.
The guidelines, issued by IRDAI in June, will be incorporated by general and health insurance companies in both the new policies filed by them on or after 1 October 2020, as well as the existing products renewed on or after 1 April 2020.
Below are some of the key changes in health insurance rules that customers need to be aware of:
Standardisation of important product clauses
IRDAI has told insurers to standardize product clauses in their policy documents so that customers can understand them easily and compare products of different companies.
The standard terms and clauses can include terms and conditions required to be met by the insured person for settlement of a claim, rules regarding policy cancellation, migration, porting, renewal, grace period or redressal of grievances etc.
Insurers would now use the same standardized wordings as recommended by IRDAI in order to understand simply the conditions, or inclusions and exclusions as stated in the policy.
New illnesses to be covered
Keeping the realities of today’s day and age in mind, IRDAI has asked insurers to now include coverage on diseases like mental illnesses, genetic diseases, neuro disorder, oral chemotherapy, robotic surgery, stem cell therapy etc.
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Besides that, age-related illnesses like cataract surgery or knee-cap replacements, which were earlier not covered under health plans, may now find place in the list of disease inclusions.
Rejection or acceptance of claims in 30 days
Insurance companies will now be required to settle or reject a claim in not more than 30 days from the date of its receipt.
In case an insurer fails to settle or reject the claim within the given time period, it would pay interest at a rate of 2% above the applicable bank rate on the dues to the policyholder.
No claim can be rejected after 8 years of paying premium
Insurers cannot reject a health insurance claim if that health insurance policy has completed eight years, i.e., if the policyholder has paid premium for eight years continuously. Moreover, re-evaluation will also not be applicable in such cases. However, this rule will not apply in case of proven frauds and permanent exclusions.
Telemedicine expenses covered
The claims can now include expenses of telemedicine i.e. for doctor’s consultations which are done through virtual modes like video conferencing, video calling, online chatting, etc.
If the original health plans covered the cost of doctor’s consultations, it would also cover the cost of telemedicine, done either before or after the main treatment that’s covered under the policy.
