Your comments are invited by IRDA on draft Health Insurance Regulations 2012

Health Insurance emerged as an important segment of Indian Insurance Industry as a result of that various initiatives were taken by the following:

IRDA Regulations Health Companies with a view to consolidate various guidelines circulars/ instructions the reputation has released.

IRDA’s exposure draft on Insurance Regulatory and Development Authority (Health Insurance) Regulations 2012

This is a serious attempt to put various points in one document. Selected Points are:

• The IRDA (Policyholder Protection of Interest) Regulations, 2002 (hereinafter referred as “2002 Regulations” shall be applicable mutatis mutandis to all health insurance policies, wherever relevant.

• Entry and Exit Age:

 All health insurance policies shall provide for entry age at least up to 65 years, except for those referred in regulation. In health insurance policies, where the covers offered are specific to a particular age groups like maternity covers, children covered under a family floater policies, cover offered to students etc, insurers shall offer an option to migrate to a suitable health insurance policy, at the renewal of the policy or at the end of the specified exit age, by providing suitable credits for all the previous policy years, provided the policy has been maintained without break.

 All health insurance policies shall not have an exit age for renewal of the policies, once the proposal is accepted, provided policy is continuously renewed without break.

• Settlement of Claim: On receipt of complete documents, an insurer shall within a period of 30 days offer a settlement of the claim to the insured. If the insurer, for any reasons to be recording in writing and communicated to the insured, decides to reject a claim under the policy, it shall do so within a period of 30 days from the receipt of complete documents.

• Timeline for Submission of claims documents:

I. Insurer may stipulate a time limit latest by which the claims documents should be furnished by the policyholder/ insured to make a claim.

II. In case of non submission of timely submission of claims documents, insurers shall not repudiate such claims unless and until the reasons of delay are categorically enquired about, reasons recorded and the insurers sufficiently satisfy that the delayed claims could have otherwise been rejected if reported in time.

III. All insurers shall develop a sound mechanism of their own to handle such claims with utmost care and caution. The insurers shall incorporate additional wordings in the policy documents, suitably providing insurer’s decision to condone delay on merit for claims which are not submitted in time, but if substantiated by the insured that the delay is beyond his/her control and due to exceptional/ unavoidable circumstances.

You as a customer are the most important link- It is suggested that you should go into details of this 44 pages document and make suggestions to IRDA by June 30, 2012. Feel free to send comments to us.