Health Insurance Rules are changed. IRDAI has released new health insurance rules which are applicable from 1st Oct 2020. The new rules are for simplifying health insurance policy and widening its scope. The rules are getting changed at the time of the corona pandemic. It is advisable to go through these new rules once to know it impacts.
Here is detail about New Health Insurance Rules by IRDAI and its impact on you.
New Health Insurance Rules by IRDAI 2020
Claim Decision within 30 Days
The decision for claim settlement or rejection needs to be given within 30 days from the date of receipt of necessary documents. This means you will get a decision about claim settlement or rejection within 30 days.
As per the new rule, the delay in claim payment is not acceptable. The health insurance company has to make payment within 45 days. In case of delay, the company has to pay interest to the policyholder from the date of receipt of the last document to the date of payment of claim at 2%.
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In case of claim require investigation in the opinion of the company, the same should be initiated and completed at the earliest not later than 30 days for the receipt of the last necessary document from the policyholder. In such a case, a company is liable to settle or reject the claim within 45 days.
Choice of Company in case of Multiple Policies
If you are holding multiple health insurance policies, you can select the health insurance company for the claim. If the amount to be claimed exceeds the sum insured under a single policy, the insured person shall have the right to choose an insurer from whom he/she wants to claim the balance amount.
A Policyholder can migrate to other health insurance products or plan offered by the company. In order to do the migration, the policyholder needs to apply for migration at least 30 days before the policy renewal date. In the case of migration, the policyholder will get continuity in coverage including the waiting period.
A policyholder can get an option for portability. The policyholder is required to apply at an insurance company for the portability. The application needs to be done at least 45 days before but not earlier than 60 days from the policy renewal date. This is as per IRDAI guidelines related to insurance portability.
The policyholder may cancel the policy by giving 15 days written notice to a health insurance company. Under such a case company shall refund the premium for the unexpired policy period. If any claim is made during the policy year, the insurance policy shall not refund any premium.
The company can also cancel the policy at any time on the ground of non-disclosure of material facts, misrepresentation or fraud by giving 15 days written notice. No refund of the premium applicable under such cancellation.
Renewal of Policy
Renewal of policy is allowed except on the ground of fraud, misrepresentation by the insured person. The insurance company is not under obligation to give any notice for renewal. The grace period is given to policyholders for the renewal of the policy.
Withdrawal of Policy
In case the health insurance company is planning to withdraw policy in the future, the company shall intimate the insured person about the same before 90 days prior to the expiry of the policy.
Free Look Period
The free look period is applicable to new individual health insurance policies. This facility is not available on renewal or portability/migration of policy. The free look period is 15 days. In case of policy surrender during the free look period, all premium shall be refunded after deducting medical examination charges and stamp duty charges.
The new health insurance policy rules are introduced towards standardization of general terms and conditions in the health insurance contracts.
As per me, it is very good steps towards standardization which will surely help policy holders in getting better services from health insurance companies.
For more information visit IRDAI Circular on Health Insurance Policies.