Right from claim settlement to getting a cashless mediclaim, policyholders have to face a lot of problems in getting their dues under a health policy. Moreover, there are stringent deadlines to be met by the policyholders in filing their medical claims; which if they (insured) fail to meet, claims are declined by the insurers. Also, until now the insurers are not mandated to provide the reason for denial of claims to the insured.

Citing such problems faced by the insured or policyholders, the insurance regulator - Insurance Regulatory and Development Authority (IRDA) has laid out a slew of changes in the insurance industry under its draft guidelines.

Let us delve deeper into the sweeping changes brought about by the IRDA

Under its draft guidelines for the health insurance companies, the IRDA has proposed to make it mandatory for health insurers to provide policy cover to people upto 65 years and settle all claims within a month. Moreover, the IRDA has also made it clear that if the policyholder is already undergoing a treatment at a hospital, and such hospital is proposed to be removed from the list of Network Provider, then insurers shall provide the benefits of cashless facility for such policy holder as if such hospital continues to be on the Network Provider list.

Some of the other important measures proposed by the IRDA in its draft guidelines are:
 

• No exit age
• Term: Life insurers at least 4 years, non-life maximum 3 years
• Claims should be serviced across the country
• Rewards for policy holders for early entry, continuous renewals, favourable claim experience.
• Premiums charged from senior citizens should be fair, transparent and duly disclosed upfront
• Loading charges and premium increase should be spelt out in advance
• TPAs should have a separate channel to address the grievances of senior citizens
• Free-look period of 15 days
• Insurers cannot reject renewals on the ground of claim experience alone
• Claims should be settled within 30 days from furnishing the documents
• Insured can claim from multiple insurers
   

Our view:

We believe that the changes proposed by the IRDA will revamp the way whole insurance industry is functioning at present and make it policyholder friendly. Right from claim settlement to policy servicing, it will be an altogether different experience for policyholders who have until now, witnessed delay in claim settlement, poor customer service, denial of claims without any proper reasoning, opaqueness about the policy sold, etc., if the proposed changes are implemented.

However, IRDA should keep proper checks and balances at both the ends; i.e., insurer as well as insured so that none of the parties are able to take undue advantage of the benefits bestowed by IRDA.

Do you think that the changes proposed by the IRDA will make life easier for policyholders? Let us know your comments or post them on our our Facebook page / Twitter page.

 

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Comments
arv746@yahoo.com Jul 15, 2012 Govt. should increase prices of Diesel - decontrol the prices.  Additional levies / duties on purchase of Diesel car is not going to solve problem permanently.  Why to punish Growth of Auto industry when Govt. is not bold enough to take decision on price increase of diesel. Govt. is scared of loosing votes, and therefore they are finding some other routes to compensate oil companies.
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mayankshahinsuer@gmail.com Jun 07, 2012 It is very vital to create special windows for senior citizen for fastest and fair claim settlement. They are the people who has funded  for many years to insurance co.s to build their kitties and when time comes for claims, insurance companies and tpa s comes with all novel ideas to harass them in all possible manners. Their claims are restricted in the name of clause of reasonable and necessary charges for which insurers have no fixed and reasonable definition. Claims are unreasonably delayed for no reason whatsoever. Agents are offered less commissions  for senior citizens which is most ridiculous.Maximum services are required to senior citizens , maximum premium is charged to senior citizens but minimum commission is offered to agents, so that agents may not take interest in them and their policies may lapse naturally ultimately benefiting to insurance companies that they have collected all premiun in their hay days but when real time comes they simply turn  back. In spite of all these , no psu has taken positive steps to help senior citizens insurance.Whereas this is their prime duty being govt.owned companies.
prem.dhankar@gmail.com Jun 09, 2012 These changes are welcomed and happy news. This will help reduce sufferings of the insured. looking forward to implementation in right direction.
sdeshpande1965@yahoo.co.uk Jun 10, 2012 I welcome this move by IRDA and expect them to improve the quality of Insurance product by setting quality guidelines.it would be more helpful if they review the Insurance companies quality standards based on the customer feedback maintained by all the companies, once in 2 to 3 years to award a quality stars, which will help new customers to select such companies and also promote healthy competition.  Most of the european companies are following this system to identify and promote good products.

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