List of IRDAI’s Rules for COVID Health Insurance, Policy Renewal, Portability & Senior Citizens

Insurance Regulatory and Development Authority of India (IRDAI) is taking every step to improve customer experience in Health Insurance Segment. Right from directing insurance companies to expediting the process to accept premium in EMIs, to ensuring the inclusion of COVID hospitalisation expenses without any exclusions, to now issuing a document stating health insurance guidelines, the insurance regulator is assuring smooth insurance/claim during difficult times of Corona Virus pandemic.

The IRDAI’s document consolidating updates on health insurance rules discusses policy renewal, portability, and provisions for senior citizens. Let’s understand these changes in detail below:

1. Underwriting

The IRDAI has directed general as well as health insurance companies to devise mechanisms to incentivise policyholders for good insurance habits such as early entry, continued renewals (if applicable), favourable claim experience, wellness and preventive habits, etc.

The insurance regulator has also said that the insurers must disclose these mechanisms upfront in the policy document as per the Product Filing Procedure Guidelines. The wellness habits and preventive habits should be clearly outlined in the document. Furthermore, the insurers should inform customers about any additional loading charge over and above the premium. These should be disclosed clearly under Product Filing Guidelines and seek customer’s consent before issuing the policy.

2. Policy Renewal

The insurers should not accept premium for renewal of policy for more than 3 months (90 days) in advance.

3. Policy Portability/ Migration

Further insurance companies are asked to offer an option to the policyholders to migrate to a suitable alternative insurance policy at the time of modification or withdrawal of the policy. Also, health policies offering indemnity benefit to minor members under family floater plans should provide a migration path at a specific exit age. The members should be allowed to migrate to suitable alternative health policy, subject to regular premium payments in the past.

There should not be any additional charge for porting the policy.

4. Provisions for Senior Citizens

The insurance regulator has directed insurance companies to ensure that the policy premium for senior citizens shall be fair and transparent. The guidelines should clearly state the same.

5. Multiple policies

The insurance regulator has directed insurers to independently settle down the claim subject to the terms and conditions of other policy. In case, when the claim is disallowed under Policy A the insurer of Policy B shall extend the total claim subject to terms and policy independently.

6. AYUSH Treatment coverage

In order to extend the scope of coverage under these lockdown times, the IRDAI has asked insurers to provide coverage for at least one or more systems under “AYUSH treatment” as per the guidelines.

All these changes are directed to ensure a smooth claim settlement. Previously, IRDA also took the following steps:

• For the ease and comfort of insurance companies and policyholders, IRDA has mandated insurers to include medical cover for COVID-19 tests and treatment in all general and indemnity related health & life policies.
• Besides, in face of financial disruptions caused to the public during social distancing and loss of business, IRDA urged insurance companies to accept monthly premiums for the policies.
• The insurers are also urged to extend the policy grace period by 30 days.
• Furthermore, the regulator has also guided each registered insurer to share detailed FAQs on COVID 19 claims on their respective websites.
• The regulator has advised insurers to expedite the settlement of claims related to COVID 19 on priority.
• IRDAI medical insurance is now made mandatory for all workers in establishments active during the nationwide lockdown.
• 29 General and Health Insurance companies are approved for marketing Arogya Sanjeevani Health Insurance Product, an affordable health insurance plan for a family, assuring a sum of Rs 1 to 5 Lakh.

So whether you are an existing insurance holder or the one who is looking for an upgrade or a new insurance plan for your parents or family, you can access insurance policies amidst COVID lockdown without any stress. Despite the lockdown, the IRDA is ensuring fast-paced service in the insurance sector. From new policy applications to making a claim, the insurance can be accessed much smoothly online in India now.