IRDA's issues exposure draft on Insurance Regulatory and Development Authority (Health Insurance) Regulations 2012
IRDA's issues exposure draft on Insurance Regulatory and Development Authority (Health Insurance) Regulations 2012.
Important points -
1- The insurer will have to provide customers all relevant information to customers in a simple language in single page.
2- The insurer will be required to provide reasons for denial of claims to insured persons
3- Health insurance claims may be settled within 30 days from the date of submission of necessary documents.
4- The insurer will make it mandatory for health insurers to provide policy cover to people up to 65 years and settle all claims within a month.
5- The insurers would have to provide cashless facility to policyholders undergoing treatment in a particular hospital even after it is removed from the list of preferred service providers. e.g. - "if the policyholder is already undergoing such treatment at a hospital, and such hospital is proposed to be removed from the list of Network Provider, then insurers shall provide the benefits of cashless facility for such policy holder as if such hospital continues to be on the Network Provider list".
6- The insurers should ensure that empanelled hospitals -- where cashless facilities are offered for policyholders -- are spread across different cities of the country and not confined only to metro cities.
7- The draft also talks about portability, under which a policy holder can migrate to another health insurance providing company, without losing any benefit.
