Concern about an individual’s health arises in the event of a medical emergency. It significantly affects the patient and those close to them, including the difficulties in obtaining sufficient financial and psychological support. Financial relief is often attainable through health insurance, provided a comprehensive policy covers the patient. Selecting a policy is at the discretion of the potential policyholder, as purchasing medical insurance for family is not a legal obligation. However, establishing trust in an insurance company raises concerns. This is where the significance of IRDA’s New Standardization Guidelines comes to the forefront.

What is IRDA?

IRDA stands for the Insurance Regulatory and Development Authority, and its meaning is elucidated in this segment. The primary objective behind the establishment of IRDA was to enhance the efficiency of the prevailing insurance industry in India and to foster new opportunities for growth. The idea to create IRDA as an autonomous body was proposed in 1999, but it officially gained statutory status in April 2000, assuming the role of regulating the insurance sector in India.

IRDAI’s New Rules: Standardization Guidelines for Health Insurance Policy:

The 2020 IRDA guidelines for health insurance concentrate on various elements, such as claim settlement and the utilisation of multiple policies. Explore the subsequent updated regulations set by IRDA:

Claim Rejection

Suppose a policyholder renews their health insurance plans for parents without a break for eight consecutive years. In that case, the insurance company is prohibited from rejecting a claim during this period, referred to as the moratorium period. The insurance company is not permitted to appeal to the IRDA against the settlement of such claims, except in cases of fraud or a claim raised against the policy’s exclusion after the moratorium period.

It is not allowed to reject any claim based on non-disclosure or mis-representation. It is illegal to deny a claim for these reasons since IRDAI has given the insurance company an eight-year opportunity to confirm the policyholder’s information.

Inclusion Of Telemedicine Under Health Insurance

The COVID-19 pandemic has compelled healthcare providers and patients alike to engage in remote consultations. The fees associated with these online consultations can accumulate to a substantial amount, resulting in a financial burden for the insured individuals. Consequently, IRDA has directed health insurance companies to incorporate telemedicine coverage where applicable. This initiative enables both medical practitioners and patients to access medical opinions without financial constraints.

Claim Settlement

There could be situations when an insurance company might delay when settling claims. Then, they will be obliged to pay the interest incurred on the delayed claim which shall be 2% higher than what banks would offer. Also, it is mandatory to settle the claim within thirty to forty five days from the date of submitting the documents to the policyholder. The specific duration will be contingent on the nature of the claim and the extent of investigation required.

Impact of New IRDAI Rules For Health Insurance Policyholders

The latest health insurance regulations from IRDA extend beyond the insurance company; they also encompass guidelines that the policyholder must adhere to in specific situations. The ensuing rules are meant to be followed by the policyholder in the respective scenarios.

1. Multiple Policies: An individual may have acquired multiple policies of identical types. In the event of a claim, the insured has the option to submit a claim to a preferred insurance company. The insurer must settle the claim as per the policy’s terms and conditions. The insurer might disapprove of the claim and then the insured may raise it under another policy if holding multiple policies.
2. Health Insurance Portability: Possibly, a health insurance policyholder will have the option to switch between plans that are similar when they find their current insurance provider’s service to be unsatisfactory. Portability of health insurance may arise in case of two situations. Firstly, the existing company replacing your current plan with an alternative. Secondly, you are transferring to a different plan offered by a different insurance provider.

In both instances, the timeframe to request migration is a minimum of 30 days before the renewal date. The application can be submitted as early as 60 days before the expiration date but not earlier. Suppose the policyholder has consistently renewed the policy without any lapses. In that case, they can anticipate porting the entire policy, inclusive of benefits and nominated individuals, under the mutually agreed terms and conditions.

Conclusion

The latest IRDAI policyholder regulations provide major improvements to the environment of family medical insurance. Increased clarity, standardised terminology, shorter waiting periods, easier portability, and longer grace periods for renewals all contribute to a more consumer-centric and accessible insurance market. These modifications enable you, as a potential policyholder, to make educated decisions when acquiring medical insurance for your family.

Before making a purchase, it is best to remain up to speed on these rules and carefully examine how they correspond with your family’s individual health needs. By doing so, you may guarantee that your family receives comprehensive and timely medical coverage in accordance with industry best practices.