Irda's health insurance guidelines hold promise
Indians will be able to buy health insurance up to the age of 65 years
and get it renewed without any exit age if the Insurance Regulatory and
Development Authority's latest draft guidelines are
implemented.
Indians will be able to buy health insurance up to the age of 65 years and get it renewed without any exit age if the Insurance Regulatory and Development Authority's (Irda's) latest draft guidelines are implemented.
These, and other guidelines, seek to transform the way health insurance is bought and used. "The guidelines could bring much more standardisation. The policyholder will know what he can expect from the firm," says T A Ramalingam, chief technical officer, Bajaj Allianz General Insurance.
However, pricing products for senior citizens will be a challenge. "The issue is that we have to price population above 75 years of age and we don't have enough data about people in that age group. So, pricing is a big challenge," says Ramalingam.
"The fact that Irda has opened up the age group up to 65 years means the higher age group will have to pay a significantly higher premium," says Arvind Laddha, managing director and chief executive officer, Vantage Insurance Brokers and Risk Advisors.
The guidelines say there will be no exit age for renewal provided the policy is renewed without break. The draft says the policyholder can access any authorised hospital in India, irrespective of whether the insurer has a tie-up with that hospital or not.
Industry officials are uneasy with the proposal. "The challenge is that if somebody is hospitalised in a remote area, how will we manage claims if we do not have a tieup with that hospital?" says Ramalingam of Bajaj.
On proposal to reimburse half the money spent on medical check-ups, Laddha of Vantage Insurance Brokers says, "At presently, some insurance companies reimburse 100 per cent, some pay 50 per cent, whereas some insurers do not pay anything." The draft says that the insurer will reimburse at least 50 per cent cost, if any, incurred by the insured during pre-insurance medical examination.
Moreover, written reasons will have to be provided by the insurer for rejecting any insurance proposal. This will apply to renewals as well.
>> Entry and Exit:
You can buy health policy up to 65 years and get it renewed without any exit age.
>> Pan-India Access:
Reimbursement from any authorised hospital, irrespective of whether it has a tie-up with the insurer or not.
>> Option to Migrate:
Policies with age-specific covers such as maternity plans, children covered under family floater policies, etc, will come with an option to migrate to a suitable policy at renewal or end of a specified exit age. The insured will get suitable credits for previous policy years, provided there has been no break in the policy cover.
>> Policy Snapshot:
Insurers will have to provide a one-page information sheet covering benefits, exclusions and grievance mechanisms.
>> No Arbitrary Rise in Premiums:
Discounts and loading (extra premium charged on renewal) shall be disclosed in the prospectus and policy document. The premium will not be allowed to be increased for one year after the product is cleared. In case of revision of premium after one year, the insurer will have to give justification along with supporting documents such as last three years' claim experience.
>> Special Provision for Senior Citizens:
Every health insurer and third-party administrator will have a separate grievance redressal and claim settlement channel for senior citizens.
>> Quick Claim Settlement:
Claims will have to be settled with 30 days of receiving all the documents. If the insurer decides to reject the claim, it has to convey this to customers within this time frame. The insurer cannot reject a claim on the basis of non-submission of claim documents within the stipulated time unless the reasons for delay are enquired about. The insurer will also have to prove that the delayed claims could have otherwise been rejected if reported in time.
>> Non-allopathic Cover:
Non-allopathic treatments to be covered provided they have been undergone in a hospital recognised by the government.
These, and other guidelines, seek to transform the way health insurance is bought and used. "The guidelines could bring much more standardisation. The policyholder will know what he can expect from the firm," says T A Ramalingam, chief technical officer, Bajaj Allianz General Insurance.
However, pricing products for senior citizens will be a challenge. "The issue is that we have to price population above 75 years of age and we don't have enough data about people in that age group. So, pricing is a big challenge," says Ramalingam.
"The fact that Irda has opened up the age group up to 65 years means the higher age group will have to pay a significantly higher premium," says Arvind Laddha, managing director and chief executive officer, Vantage Insurance Brokers and Risk Advisors.The guidelines say there will be no exit age for renewal provided the policy is renewed without break. The draft says the policyholder can access any authorised hospital in India, irrespective of whether the insurer has a tie-up with that hospital or not.
Industry officials are uneasy with the proposal. "The challenge is that if somebody is hospitalised in a remote area, how will we manage claims if we do not have a tieup with that hospital?" says Ramalingam of Bajaj.
On proposal to reimburse half the money spent on medical check-ups, Laddha of Vantage Insurance Brokers says, "At presently, some insurance companies reimburse 100 per cent, some pay 50 per cent, whereas some insurers do not pay anything." The draft says that the insurer will reimburse at least 50 per cent cost, if any, incurred by the insured during pre-insurance medical examination.
Moreover, written reasons will have to be provided by the insurer for rejecting any insurance proposal. This will apply to renewals as well.
KEY PROPOSALS
>> Entry and Exit:
You can buy health policy up to 65 years and get it renewed without any exit age.
>> Pan-India Access:
Reimbursement from any authorised hospital, irrespective of whether it has a tie-up with the insurer or not.
>> Option to Migrate:
Policies with age-specific covers such as maternity plans, children covered under family floater policies, etc, will come with an option to migrate to a suitable policy at renewal or end of a specified exit age. The insured will get suitable credits for previous policy years, provided there has been no break in the policy cover.
>> Policy Snapshot:
Insurers will have to provide a one-page information sheet covering benefits, exclusions and grievance mechanisms.
>> No Arbitrary Rise in Premiums:
Discounts and loading (extra premium charged on renewal) shall be disclosed in the prospectus and policy document. The premium will not be allowed to be increased for one year after the product is cleared. In case of revision of premium after one year, the insurer will have to give justification along with supporting documents such as last three years' claim experience.
>> Special Provision for Senior Citizens:
Every health insurer and third-party administrator will have a separate grievance redressal and claim settlement channel for senior citizens.
>> Quick Claim Settlement:
Claims will have to be settled with 30 days of receiving all the documents. If the insurer decides to reject the claim, it has to convey this to customers within this time frame. The insurer cannot reject a claim on the basis of non-submission of claim documents within the stipulated time unless the reasons for delay are enquired about. The insurer will also have to prove that the delayed claims could have otherwise been rejected if reported in time.
>> Non-allopathic Cover:
Non-allopathic treatments to be covered provided they have been undergone in a hospital recognised by the government.
