Life insurance companies will soon be allowed to tie up with non-life companies to offer health-plus-life combi products.
The Insurance Regulatory and Development Authority (Irda) on Thursday said the product would be a combination of a pure term product covering life risk and a health insurance cover.
However, a life insurer will be allowed to tie up with only one non-life insurer and vice-versa.
Life insurance companies will provide the term product covering life, whereas non-life insurers will underwrite the health insurance policy.
Irda on Thursday released the draft guidelines on health insurance policies.
| HIGHLIGHTS |
| * Health insurance policies should provide an entry age of 65 years |
| * 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 form 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 |
It said mediclaim policies should have an entry age up to 65 years, but no exit age.
This means once a policy is issued, the insurer will have to renew it life long. But the insurer will be allowed to raise the premium, based on the age of the insured.
The regulator said health insurance policies offered by life insurance companies should have an entry age of at least four years and non-life insurers would issue a policy with a maximum term of three years.
This is aimed at providing continuity in the policy.
Irda also said an insurer could not deny policy renewal simply on the basis of the claim experience.
Also, any loading charge or rise in premium should be spelt out in detail at the time of issuing the policy.
Customers should have the option to use the bonuses accrued by way of lower premiums of the higher sum insured and in case of claims, the sum assured should come down in a pro-rated manner.
A customer will have 15 days after the issuance of the policy to decide whether to take the plan. Besides, insurers will have to devise reward schemes for policy holders for early entry, continuous renewals, favourable claim experience and others.
Insurers will have to settle claims within 30 days of the receipt of complete documents.
They would have to stipulate a time limit by which the claims and documents should be furnished by the insured. However, in case of a delay in the filing of documents, insurers should not deny such claims unless the delay was deliberate.
Policyholders having multiple health insurance policies can claim from multiple insurers, if the benefits covered are fixed in nature and the contributory clause shall not be applicable in this case, the guildelines said.
A contributory clause describes how much the issuer must pay, if there is insurance in more than one company on a given loss.
Policyholders will decide on the insurer with whom the claims are to be settled with multiple insurers.
