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NEW DELHI: Soon, insures could be solely responsible for gathering claims information of a policyholder from existing insurer following the porting of a health policy. As a result, insures will not be able to repudiate claims on the grounds of non-disclosure. Also, insurers will have to seek necessary medical and claims history of a policyholder from existing insurer within five working days of receipt of portability form.
The proposed changes by the Insurance Regulatory and Development Authority of India (Irdai) aim to make policyholders less accountable while porting their health insurance policy.
Nikhil Kamdar, appointed actuary, Digit Insurance, said as per the proposed guidelines, insurers will be responsible for obtaining previous claims history from the existing insurer of the policyholder. Earlier, it was the insured's responsibility to disclose these details to the new insurer, and future claims could be rejected if such details were not shared explicitly at the time of porting.
"Further, insurers have been advised to publish on their websites all information on the sequence of steps that need to be followed in addition to the responsibilities of the policyholder while porting their policy. The proposed changes could make policyholders less accountable while porting and increase the responsibility on insurers as they would have to carry out enhanced due diligence," said Kamdar.
The guidelines have also prescribed a five-day period from receiving the portability form for the port-in insurer to seek all necessary information from existing insurer.
Naval Goel, Founder and CEO, PolicyX.com, said by making portability a time-bound process, Irdai aims to ensure that policyholders will not have their requests pending for an undefined period.
"Since portability is quite a common trend in health insurance and it was primarily done manually, which you used to consume at least 15 days, or more, this mandate was quite essential. During this course, the policyholders were never sure whether they would get the new policy or not and if they didn't get the health insurance from the new insurer, that would put them in a difficult situation. However, this won't be the case with these new draft amendments," said Goel.
Besides, Irdai has also proposed that insurers arrange an adequate number of public and private sector network providers across geographies to provide cashless facility. Goel said, "The prime focus of health insurance is to provide cashless facilities to the policyholders during a dire situation. However, policyholders have to suffer due to the non-availability of the network hospitals. Hence, this mandate will further signify the importance of health insurance and ensure higher reliability on customers' insurance policies."
Irdai, in consultation with the Insurance Advisory Committee, has proposed these amendments in regulation. The draft is under review, and Irdai has asked stakeholders to share their feedback.
