The Insurance Regulatory and Development Authority of India regulates, manages and oversees the insurance industry. This includes drafting and implementing updates to policy clauses.
They have released another set of guidelines for health insurance policies that will be in effect from 1 April 2024. So, if you are planning to buy health insurance, you need to know these updates.
6 New IRDAI Guideline Updates Regarding Health Insurance Regulations
● Plans for All Age Groups
The entry age group refers to the maximum age of policyholders allowed to buy a health insurance policy preferred by insurers. This allowed them to avoid taking policy seekers who were senior citizens and at risk of serious health issues.
The IRDAI has eliminated this condition. Now, insurers cannot apply age-based criteria when accepting policyholders. This is especially useful for senior policy seekers who can now compare health insurance plans and buy the best of the best policies available.
● Waiting Period Reduced
The waiting period of a policy refers to the predetermined time frame allotted by the insurance company during which you are prohibited from filing a claim. Usually, health insurance rules and regulations mention that a policyholder had to wait for four years before they could raise a claim under a pre-existing disease policy or specific disease policy.
The changed IRDAI health insurance regulations state the waiting period for pre-existing disease plans and specific disease policies will be three years. This significantly increases the profitability of the health insurance policy.
The new health insurance portability rules also state that if you port your policy to another insurance company, the waiting period you served at the past company will be credited.
● Cashless Claims Everywhere
Cashless claims refer to the medical policy feature that allows you to get treated and hospitalised in a hospital without any physical cash or plastic money. The policy providers will settle the claim for you directly, reducing out-of-pocket expenses.
Initially, the cashless claim feature was applicable only for network hospitals, i.e., the hospitals that were affiliated with the insurance company. However, according to the new health insurance rules and regulations, you can claim this medical policy feature at any hospital in India. Your claim will be settled according to the terms and conditions mentioned in your policy.
From 1 April 2024, according to the new health insurance regulations, insurers are supposed to settle your cashless claims within one hour of filing.
● Claim-Free Term Rewarded
A claim-free policy term leads to a no-claim bonus. This means when you do not raise any claim throughout the policy period, you receive a no-claim bonus. In health insurance policies, the no-claim bonus is used to reflect on the coverage or sum assured.
According to the change in health insurance rules and regulations, policyholders now have a choice after a claim-free policy year. IRDAI now asks policyholders to choose between two options: increasing policy coverage and scope or reducing premium amounts to reduce the cost of the medical policy.
● Reduced Cancellation Charges
Cancellation charges are the charges you used to pay to go through the process of cancelling your health insurance policy. Before the new guidelines, cancellation charges used to be really expensive, which made cancellation a difficult decision.
However, with changed guidelines of health insurance regulations, the policyholder can cancel their policy by giving their insurer a written cancellation notice of 7 days.
The insurance company will have to refund a proportionate amount of the premium for the remaining policy term, which should be up to one year with no claims raised.
● Claim Rejection Process
Claim rejection involves the evaluation of your claim, surveying, and approving or rejecting it. The change rules state that this process cannot take place under a single individual’s supervision. Instead, the process will be seen through by a 3-member group, increasing the transparency of the claims process.
Conclusion
As a citizen, you might find it difficult to navigate the complicated terrain of health insurance policies and their changes. However, with free access to information through the Internet, you can be aware of all the changes. This awareness will help you enjoy multiple benefits.
Moreover, being updated with these guidelines will also help you evaluate your options and make more informed decisions when buying health insurance from reputed providers like TATA AIG in the future.
