Hyderabad, Mar 16:
In a bid to check any unjustified and arbitrary rise of health premiums by insurers, the insurance regulator IRDAI , on Tuesday, has revamped the existing regulations and has asked insurers to file its compliance reports to their boards and to the IRDAI every year.
The insurance regulator has also disallowed general and health insurers to modify the existing benefits, add new benefits in the existing health insurnace products which leads to imposing an increase in premium.
“Addition of new benefits / up-gradation of existing benefits may be offered as add-on covers or optional covers with a standalone premium rate to ensure an informed choice to the policyholders,’’ said the IRDAI.
However, it has allowed insurers to effect minor modifications as stipulated in the existing regulations
The IRDAi has said the appointed actuary of an insurance company should review the financial viability of every health insurance product at the end of every financial year and the report of such review should be submitted to their board along with the analysis of favorable or unfavorable experience of each product as well as recommended corrective action, to ensure sustainability of the product and to protect the interests of policyholders of the underlying product.
“A status report of insurers' health portfolio should be submitted by 30th September of every financial year to the IRDAI along with the board’s suggestions and the corrective actions to be taken in the format specified by us,’’said IRDAI.
Last but not the least,, IRDAI has asked insurers to ensure that the policy wordings must be simple using plain language.
“In order to enable all sections of policyholders easily understand the contents of policy contract, all insurers should arrange the policy contracts of all health insurance products in the order we have specified and with clear heading so as to draw the attention of policyholders,'' said the IRDAI. .
This format should be adopted in respect of all policies issued from 01 October, 2021 onwards,’’ said the IRDAI.
The status report for FY 2020-21 should be filed by 30th September, 2021.
Among other things, the policy should clearly mention benefits covered under the policy, exclusions (to be divided into Standard Exclusions (exclusions for which standard wordings are specified by IRDAI) and specific exclusions, general terms and clauses with clear demarcation and sub title and other terms and conditions
The wordings of all the standard exclusions, standard terms and clauses and standard definitions used in the policy contract should comply with the wordings as specified by the IRDAI.