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The Health Insurance industry undergoing a drastic shift both from consumer behavior and industry to cope with it regulators are bound to bring changes for the welfare of the consumers.
IRDA or Insurance Regulator Development Authority is the apex body that controls the insurance industry as RBI controls the Banks. Health insurance history in India began with an Employee's state insurance scheme (ESIS) in 1948. It was introduced as an umbrella of social security for blue-collar workers of the organized sector. It provides health care services through a network of dispensaries and hospitals that impaneled with ESIS.
The Insurance Regulatory and Development Authority (IRDA) had issued a circular, making it effective from 1 October 2011, directing insurance companies to allow portability from one insurer to another and from one plan to another. This means one can port credits on time-bound exclusions and no-claim bonuses. However, this credit will be limited to the sum insured (including bonus) under the previous policy.
Well, IRDA keeps changing the rule and conditions in favor of consumers which benefit the mass consumer of health insurance. The new rules come at a time when the continuous spread of coronavirus pandemic has made an extra mile to safeguard.
With effect from 1st October 2020, the new rules are effective; the holder of health insurance policy must check it.
Rule 1- Decision On A Claim Within 30 Days
According to the new guidelines, released by IRDAI in June, insurance companies will be required to either settle or reject a claim not more than 30 days from the date of its receipt, under certain conditions.
Claim plays a vital role in any insurance companies however when it comes to health insurance this becomes imperative in regards to time. For example, if a policyholder does not get the claim on time then or is not intimated then on the part of the policy holder it may create mayhem.
Rule 2- Any Delay Means Interest
Experience of policyholders in regards to claiming settlement was up to satisfaction level, claim got settled undoubtedly, however, payments are made after waiting in the long queue. To curb such practices, IRDA has brought a mechanism of 2 % penalty if the decision is not taken within the stipulated time. Insurance companies need to pay 2% on outstanding amount due to the policyholder.
Rule 3- No Rejection, After 8 Years
Rajesh Choudhury
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