With the IRDAI introducing new regulations for health insurance policies, should I be aware of any significant changes before renewing my plan? How could these updates affect my policy? 

Riya

The IRDAI has recently made significant strides to simplify health insurance for customers. Over the past few years, they have focused on addressing several issues that often obscure customer decision-making. These changes aim to enhance customer benefits, making it easier for the general public to optimise their insurance policies. Let’s delve into a few key points:

One of the most notable developments is that health insurance policies now incorporate AYUSH and modern treatments, reflecting a growing acceptance of alternative therapies in consumer preferences. Insurers are required to offer a broader range of products, add-ons and riders to meet these evolving customer needs. Another significant change is that after maintaining a policy for five continuous years (60 months), insurers cannot deny claims or refuse renewal, based on unintentional non-disclosure of pre-existing conditions. This ensures peace of mind, allowing you to focus on your health without the fear of losing coverage due to minor oversights.

Another significant change that brings relief to many is the waiting period for pre-existing conditions in health insurance policies. The waiting period for pre-existing conditions and specific diseases is now capped at a maximum of 36 months for all policyholders. This means that individuals with pre-existing conditions will no longer face excessive delays before their coverage becomes effective. Additionally, the IRDAI has mandated that insurance companies process cashless requests within one hour and finalise approvals within three hours. This enhancement guarantees timely support during critical moments, alleviating concerns over hospital bills.

Another important aspect is the emphasis on transparency and consumer protection. The IRDAI has made it mandatory for insurers to provide a Customer Information Sheet (CIS), which discloses the benefits and other essential clauses clearly and concisely, making it easy for the customer to understand their policy document. Customers now have a 30-day period from receiving their health policy to review its terms and conditions, during which they can cancel the policy if they feel uncomfortable with any details. Additionally, premium payments have a grace period: if you pay monthly, you have an extra 15 days to settle your dues without losing coverage, while quarterly, half-yearly and annual payments enjoy a 30-day grace period. This ensures continuous coverage during that time. Furthermore, the process for porting policies between insurers has been streamlined, with a five-day mandated response time for porting requests. Further, if you’re dissatisfied with your insurer’s services, you only need to provide seven days’ written notice to cancel your policy.

These updates can significantly enhance your health insurance policy. The expanded coverage for advanced treatments offers you better options for receiving care in various situations. With the waiting period for pre-existing conditions now capped at 36 months and the non-contestable clause after five years, you gain greater security and peace of mind. Additionally, faster cashless authorisations and simplified policy cancellations improve accessibility and flexibility, allowing you to manage your healthcare needs without financial stress. Overall, these new coverages provide enhanced protection, security and a more user-friendly experience.

The writer is MD&CEO, Bajaj Allianz General Insurance

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