How India's Insurance Watchdog Is Helping Health Cover Policyholders With Latest Changes

With a vision of ‘insurance for all by 2047’, the Insurance Regulatory and Development Authority of India (IRDAI) has been working to make insurance products a lot more customer-friendly.

Some of the key steps that have been taken are:

• To ease the load on customers IRDAI has mandated that cashless treatment will be available to the customer in all hospitals, irrespective of whether the hospital is in the network of insurer or not. This step will ensure that customers don’t have to dip into their savings to pay the bill and then follow the tedious reimbursement process.
• In another move to make the customer experience better IRDAI has mandated that cashless claims have to be settled within 3 hours of receipt. This will make sure that unnecessary waiting time is avoided and the customer does not have to wait for hours to hear back from the insurer.
• Pre-existing disease period has been brought down from 4 to 3 years. This step balances the need for prudent underwriting to protect the insurance industry from unfair and fraudulent claims as well as making sure that insurance policies become fairer to genuine customers. This step is likely to encourage many people with illnesses to consider taking up insurance
• One common complaint that many insurance customers have is that they pay for insurance for years and when the time comes for their health claims the company rejects the claim citing non-disclosure. While insurance industry data shows that this is something that does not happen frequently and the Indian insurance industry is overall a fair industry, it cannot be denied that such instances do occur. To address this issue IRDAI has cut down the moratorium period to 5 years, which means that if you have been with an insurer for more than 5 years then the insurer cannot reject a claim on any grounds, except fraud. This step will also go a long way in assuring the customers that their premiums are not going to waste.
• Another customer-friendly step that has been undertaken by the IRDAI is that in case the customer has multiple insurance policies the task of coordinating between insurers is to be managed by insurance companies and not the customer.
• A customer can make a claim even if the policies are with multiple insurers. This step will be of great benefit to customers who have group insurance policies from their employers as well as their own. This will ensure that the customer does not have to manage documentation and interact with multiple people. Customers with top-up policies will also benefit from this.
• Alternate forms of treatment like ayurvedic, yunani, homeopathy, etc, which are collectively known as AYUSH have been brought to par with allopathy. This means that the claims on an AYUSH treatment will not be subjected to any special condition or capping.

With all these steps we believe that the insurance industry will gain more trust in the customer’s minds and encourage them to purchase more insurance.

-The author is the CEO of CarePal Secure. Views expressed are personal.