Some of the important points consolidated in these guidelines are as follows:
Insurance of health insurance products
According to the Insurance Regulatory and Development Authority of India (IRDAI) guidelines, general insurers and health insurance agents may devise mechanisms or incentives to reward policyholders for rapid entry, continued renewal (where applicable), favorable claims experience, prevention and wellness habits. These incentives / mechanisms, etc., must be published in advance in the prospectus and policy document by complying with the standards specified under the Product Filing Procedure Guidelines. The guidelines add that what is proposed to be covered as part of wellness and preventive habits should be clearly defined in each insurance product.
The insured must be informed in writing of any insurance charge that is charged in addition to the premium filed and approved under the product filing guidelines and specific consent of the policyholder for such charges is obtained before issuing a policy, the guidelines say.
Renewal of health policies issued by general insurance companies
Under these guidelines, the renewal premium is accepted no more than 90 days prior to the due date of the premium payment.
Migration of health insurance
Under the IRDAI Circular, general insurance companies and health insurers offering compensation-based health coverage must offer an policyholder an opportunity to migrate to an appropriate alternative health insurance policy available at the time of policy change or withdrawal. In addition, non-life insurance-based health coverage offered to specific age groups, students, children under family-run policies must also offer an opportunity for such lives to migrate to an appropriate alternative health insurance policy available in the specific age of retirement. Each migrated policy is allowed appropriate credits for all previous policy years, provided the policy is maintained without pause.
The standards for migration and transfer of all policies issued by general insurers and health insurers are subject to the guidelines that the authorities may from time to time specify under the circular.
Special provisions for the elderly
The premium for health insurance products offered by life insurers, non-life insurers and health insurance companies for the elderly must be fair, justified, transparent and properly disclosed, the guidelines say.
Residual claims or claims not permitted under the previously chosen policy / policies may be made from the other policy / policies, even if the insured amount is not used up in the previously chosen policy. In such cases, the insurer (s) must independently settle the claim subject to the terms and conditions of other policies / policies selected in accordance with the guidelines.
Transfer of health insurance policies
In order to accept a policy concluded, the insurance company does not have to charge additional surcharges solely for the purpose of porting, cf. the circular, the guidelines say.
All insurance companies may endeavor to provide coverage for one or more systems covered by “AYUSH treatment”, provided that the treatment has been conducted in hospitals or health facilities subject to guidelines that may be specified by the authority at any time.
Wellness and preventive aspects
Insurers may endeavor to promote the well-being of health insurance policyholders in accordance with the guidelines that the regulatory authority may from time to time specify, according to the circular.