New delhi: To streamline the health insurance industry and protect the interests of policyholders, the regulator on Thursday issued draft regulations spelling out product pricing and design norms as well as measures on renewal and portability of policies.
The Insurance Regulatory and Development Authority (Health Insurance) Regulations 2012 seek to capture the best practices in the health insurance sector and strengthen the industry in India, Irda said in a statement.
“This is basically a consolidation of various circulars and guidelines issued by Irda in the recent past on health insurance and offers a comprehensive guideline on matters relating to underwriting, claims and product as well as guidelines for TPAs (third-party administrators),” said B. Subrahmanyam, head, health, commercial lines and reinsurance, at Bharti Axa General Insurance Co. Ltd.
The size of the health insurance industry in India is around Rs 13,000 crore, according to industry estimates.
Irda (Insurance Regulatory and Development Authority) has published the draft regulations on its website inviting comments from stakeholders by 30 June.
As per the draft, all health insurance policies should provide for an entry age of at least 65 years. It also says insurers should not specify an exit age for policy renewals if a policy has been renewed continuously without a break.
Life insurers have to offer products for individuals with policy terms of at least four years and non-life insurers can offer products for not more than three years, it says.
Irda also says in the draft that an insurance company cannot reject the renewal of a health insurance policy on the grounds that a policyholder made a claim in the previous years.
Health insurers and TPAs have been directed to also establish separate channels to address health insurance-related claims and grievances of senior citizens.
In cases where the covers offered are specific to particular age groups, such as maternity covers, children covered under family floater policies and covers offered to students, insurers will have to offer options to their customers to migrate to another health insurance policy at the time of renewal or exit by providing credits for all the previous policy years.
The draft also says that policyholders having more than one policy from different insurance companies can chose which insurer to settle a claim with.