Straight from the Specialists
Health insurance in new, improved avatar
(The views expressed in this column are the author’s own and do not represent those of Reuters)
“Till now our focus was to work as a development authority but now it has been more than a decade and it is time to act as a regulatory authority,” Hari Narayan, the chairman of India’s Insurance Regulatory and Development Authority (IRDA) was quoted as saying in a recent interview.
These draft guidelines, if implemented, will go a long way in setting up a truly useful and efficient health insurance mechanism in India. It has attempted to cover all aspects of a health insurance plan — from simplifying the product documents and design, enabling some very useful features, protection of the policyholders’ interest, efficient and transparent claims handling, portability and issues mostly faced by senior citizens (this is a pain area currently).
Listed below are the key points of this proposal. For the sake of simplicity, I have mentioned only those policies sold by general insurance companies to individuals.
– All policies should allow entry till the age of 65
– Once proposal is accepted, policies will not have an exit age
– Policies will allow treatment in any hospital across India, except from un-authorised ones
– Insurer shall not compel the insured to migrate to other health insurance products, if it is to the disadvantage of insured
– If a proposal has been denied, the reason has to be given in writing
– Refund 50 pct of cost incurred in pre-insurance medical check if proposal is accepted
– Separate channel to address grievances of senior citizens
– If a person has multiple health insurance policies, the customer has the option to chose the insurer with whom the claim needs to be settled
– A simple document explaining the key features and benefits of the plan is to be presented to the customer
– Policy must be renewed unless in case of fraud or misrepresentation of facts
– Greater clarity on portability norms
– Claim settlement within 30 days
You can download and read the complete set of guidelines by clicking here.
This is indeed a laudable effort by the regulator and gives a very clear direction to the way it wants the industry to flow, giving a lot of importance to consumer protection. Consumer protection increases consumer confidence which will result in increased growth in the sector which is critical even to the country’s economic health.
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