Given the gradual rise in popularity of health insurance products, the Insurance Regulatory and Development Authority (IRDA) had back in January 2012 issued regulatory guidelines to insurance providers selling health insurance plans.
While the IRDA guidelines PDF gives out an exhaustive list of do’s and don’ts for insurance companies marketing and selling health insurance products, here is a simplified version of 14 notable and lesser known facts about health insurance that every individual purchasing a health insurance policy should be aware of.
Fact 1 – Under General Provisions
An insurance company cannot force a policy holder to migrate to other insurance products if the policy holder is at disadvantage.
Fact 2 – About Entry and Exit Age
Once a policy proposal is accepted, insurance policies should not have an exit age at the time of policy renewals provided the policy holder has continuously renewed the policy without any lapses.
Fact 3 – On Pan India Access
Health insurance policies should allow access for treatment even in hospitals that are not part of its network provider hospitals except in case of those hospitals that are not authorized to provide healthcare services via health insurance policies.
Fact 4 – About Underwriting
Denial of health insurance by any health insurance provider should be furnished and explained in writing with the appropriate reasons for denial.
Fact 5 – For Senior Citizens
The premium chargeable on mediclaim insurance products for senior citizens should be fair, duly justified, transparent and disclosed upfront with no hidden clauses.
Fact 6 – For Senior Citizens
A separate channel for communication for senior citizens should be provided to address health insurance claims and other grievances.
Fact 7 – For Senior Citizens
A health insurance provider cannot increase the premium for a period of 1 year once the product is cleared and approved by the regulatory authority.
Fact 8 – On Free Look Period
Health insurance policies should have a free look period applicable immediately after the policy has been issued. Free look up essentially means the period of time within which a policy holder can chose to return the policy and claim a refund.
Fact 9 – On Free Look Period
The policy holder has a time-frame of 15 days from the date of receipt of the documents to review the terms and conditions of the policy.
Fact 10 – On Free Look Period
If the policy holder disagrees to any terms and conditions, he or she can opt to return the policy mentioning his reasons for objection.
Fact 11 – About Multiple Policies
If the policy holder has subscribed to 2 or more health insurance policies during a period from different insurance providers wherein the sole objective of the policy is to avail of treatment costs, the insurance provider cannot apply the contribution clause and has to oblige by duly settling the claim.
Fact 12 – About Non-allopathic Coverage
Some insurance providers may provide coverage for non-allopathic treatments provided the policy holder opts to undergo the treatment in a government hospital or other government recognized institutes.
Fact 13 – About Renewal
The insurance provider cannot reject the renewal of a health insurance policy on the grounds that the policy holder has made claim(s) in the previous years.
Fact 14 – About Settlement of Claim
Upon receipt of all necessary documentation, it is mandatory for the health insurance provider to offer settlement of claim within a period of 30 days. If for some reason the claim is rejected, the insurance provider needs to notify the policy holder about the same within the same time-frame.
