The separate information sheet accompanying a health insurance policy has to be also signed by the customer before policy is getting issued by the insurer

Hyderabad:

Further streamlining the customer friendly features in a health insurance policy, segment regulator IRDAI has asked the insurers to provide the key details of policy including Name of Insurance Product/Policy, Sum Insured(Along with amount), Policy Coverage, Exclusions, Claim settlement and Grievances management Procedures to the customers in a separate `Information Sheet’ .

The separate information sheet has to be also signed by the customer before policy is being issued by the insurer.

`Insurers have to  provide web-link where the product related documents including the Customer Information sheet are available on the website of the insurer. In case of any conflict, the terms and conditions mentioned in the policy document  will prevail. Insurer to take confirmation of the policyholder regarding receiving of the `Customer Information Sheet’” said the IRDAI in its exposure draft released on Wednesday.

The insurers in a `Customer Information Sheet’ have to provide the customer some of the the following details:

Type of Insurance Product/ Policy:

-Indemnity (Where insured losses are covered up to the sum insured under the policy),

– Benefit (Where an insurance policy pays a fixed amount under the policy on the occurrence of a covered event,

– Both Indemnity and Benefit(where policy has  elements of both the above)

Sum Insured (Basis, along with amount)-

-Individual Sum Insured -Where each member has a separate sum insured under the policy), or  Floater Sum Insured-where all members under the policy have a single sum insured limit which may be utilised by any or all members

Policy Coverage (What the policy holder is covered for?

-Financial limits of coverage ie. Sub-limit (It is a pre-defined limit and the insurance company will not pay any amount in excess of this limit)

Claims/Claims Procedure:

-Details of procedure to be followed for cashless service as well as for reimbursement of claim includingpre and post hospitalization. Turn Around Time (TAT) for claims settlement:

-Insurers have to provide the details /web link for Network Hospital details, Helpline number and Downloading/getting claim form.

Grievances/Complaints:

-Details of grievance redressal officer of the insurer – Insurance company grievance portal/ Department: – Ombudsman: (contact details, Toll free number/email)