The Indian Insurance regulator IRDA (Insurance Regulatory and Development Authority) plans to make the settlement of claim within a month (30 Days) mandatory, according to the draft guidelines on IRDA (Health Insurance) Regulations 2012 which were released for feedback from all stakeholders.
Highlights of Draft Guidelines..!
* If the insurer decides to reject a claim, it should also be communicated to the policyholder, in writing, within the same period.
* Even in the case of non-submission/timely submission of claim documents, the insurers should not repudiate such claims until the reasons for delay are categorically enquired.
* All the insurers should develop a sound mechanism of their own to handle such claims with utmost care and caution. They shall incorporate additional wordings in policy documents.
* With reference to combination products which are generally termed as ‘Health Plus Life Combi Products', IRDA said they could be promoted by all life and non-life insurance companies.
* Such products should have a pure term life insurance cover offered by life insurance companies & health insurance cover offered by non-life insurance companies.
* The insurance companies should enter into a formal memorandum of understanding on the modus operandi of marketing, policy service & sharing of common expenses with prior approval.
* The premium components of both risks are to be separately identified & disclosed to the policyholder at both pre-stage and post-stage sale in all key documents.
* A combination product might be offered both as individual insurance policy & on group insurance basis.
* Insurers should submit the information regarding health insurance business in the specified format for the period ending September and March of every year to the IRDA.
The final guidelines on health insurance are likely to be notified some time after June 30, 2012.
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