IRDAI Mandates Insurance Companies to Provide Wider Range of Option to Policyholders

IRDAI has recently introduced newer guidelines to ensure health insurance is more inclusive and provides policyholders with options to customise their products. However, companies don’t need to include every illness or treatment but create products with more add-ons and riders to meet the needs of different age groups.

Since the awareness about health insurance reached its peak post-pandemic, people have actually been on the lookout for products that cater to their needs and are tailor-made to include their specific requirements. In this wake, IRDAI has come up with various guidelines and rules from time to time to ensure the inclusivity of the masses and better coverage of the products they choose. Accordingly, the IRDAI has mandated that insurance companies provide a broader range of options for policyholders, including domiciliary hospitalisation, outpatient treatment, daycare, home care, cashless treatment, reimbursement options, and hospital stay. However, not all plans need to have every other option, illness or treatment covered. The initiative taken by IRDAI is to ensure that there are more products launched in the market that create diverse add-ons, or riders tailored to meet the needs of different groups, such as senior citizens, children, and disabled individuals. So the policyholders can select the coverage that best suits their specific needs. IRDAI has also mandated that insurers cannot reject claims of policyholders who have continuously held a policy with the company for 5 years (60 months) on grounds of unintentional non-disclosure of pre-existing conditions. IRDAI has also mandated insurance companies to respond to cashless authorisation requests within one hour and finalise discharge approvals within three hours.

Apart from this, policyholders now have 30 30-day free look-up period from the receipt of the policy document to review its terms and conditions. If they are not satisfied with the policy they can cancel it during this period. The waiting period for pre-existing and other specified diseases has now been capped to 36 months and a 15-day grace period is granted to policyholders to settle dues for monthly instalments. For policyholders paying premiums quarterly, half-yearly and annually the grace period is up to 30 days. Also, in case of cancellation and portability, the policyholder needs to give written notice of only seven days to cancel, and the insurer is obligated to refund the proportionate premium for the unexpired policy period. This applies to policies with a minimum duration of one year, provided no claims have been made during the policy period. For porting from one insurer to another the regulator now mandates a response time of five days on receiving a porting request. The acquiring insurer must communicate the proposal immediately, but no later than five days after receiving the information.