Health insurance policies are often filled with jargon, which can make it difficult for policyholders to fully benefit from comprehensive health coverage.
Companies like ACKO Insurance provide easy-to-understand coverages and benefits. To make health insurance more user-friendly for everyone, the IRDAI has launched new regulations. Let's understand the key changes and how they can impact your policy and coverage.
#1 Moratorium period
The moratorium period is the period after which the insurers can reject health insurance claims only because of fraud or other permanent exclusions. Previously, this moratorium period was eight years, which has recently been reduced to five. This means that policyholders' claims cannot be rejected for misrepresentation of information after 60 months of continued coverage (including migration and portability).
#2 Pre-Existing Diseases (PED)
Insurers often fail to cover PEDs, at least until the waiting period, but there is a lack of clarity on what can be declared as PEDs. Effective April 1, 2024, a PED is any ailment, condition, disease, or injury diagnosed or treated or medical advice recommended in the last 36 months before policy commencement. It paves the way for honest disclosure during policy applications, further reducing claims processing complications.
#3 Removal of Age Limit
Senior citizens over 65 years of age have difficulty obtaining a comprehensive mediclaim policy. IRDAI has now instructed insurers to provide coverage for everyone regardless of age. This can dramatically increase the number of policyholders in India as more elderly people will come forward to purchase insurance, even with PEDs. Insurers can create customised and innovative products with varying entry age limits. For existing policyholders, it allows for lifetime renewability.
#4 Cashless Claims Approval and Settlement
Insurers are obligated to offer 100% cashless claim settlement without time delay. Requests for cashless authorisation must be answered within one hour of receiving the request, and final authorization for discharge must be approved within three hours. The policyholder should not be made to wait in any case, and any additional charges from the hospital must be paid by the insurer from their shareholder's fund. Digital pre-authorisation can also be issued to expedite this process. In case of death, claim settlement must be done immediately.
#5 Free Look Period and Cancelation
Generally, when you buy a health insurance policy, you are locked for the policy period, which is a year from the date of purchase. IRDAI has allowed a free look period of 30 days, allowing the policyholder to cancel their policy without any charges or penalties. Also, an indemnity-based policy can be cancelled any time during the policy term with 7 days of written notice. The insurer must refund the premium corresponding to the unexpired policy period.
#6 Claims Allowed with Multiple Policies
Individuals may often have different health insurance policies and different providers. They can file a claim settlement with an insurer of their choice as the primary insurer. If the available coverage according to the policy is less than the allowed claim amount, the insurer can get details of other policies and coordinate with other health insurance providers to ensure settlement of the balance amount based on policy conditions. With benefit-based policies, policyholders can claim from all insurers under all policies.
#7 Issuing Customer Information Sheet (CIS)
Every policy provider must provide a standardised CIS containing all the basic policy features explained in simple terms. This increases awareness about health insurance policy and makes it more consumer-friendly. The policyholder can understand coverage, exclusions, and policy benefits with a single look.
Takeaway
IRDAI's measures are meant to standardise insurance operations and improve transparency. It protects policyholders' interests and streamlines claim processing. It can lead to a complete transformation of the insurance industry with more emphasis on user experience, prompting insurers to be more diligent with their services.
Interested in optimal financial protection within your budget? Check out ACKO health insurance plans that are completely customisable to meet your medical insurance needs.
(This article is part of DMCL Consumer Connect Initiative, a paid publication programme. DMCL claims no editorial involvement and assumes no responsibility, liability or claims for any errors or omissions in the content of the article. The DMCL Editorial team is not responsible for this content.)
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