The Insurance Regulatory and Development Authority (IRDA) has introduced a new circular in health insurance sector. From July 1, all the people up to the age of 65 years are elligible for health insurance.
Any company denying health cover to a senior citizen should furnish a documented reasoning. Companies are not allowed to charge excessive premium rates for senior citizens. Details of extra charge, if any, should be communicated to the insured.
Insurers are instructed to communicate the differences in product specifications for different age groups upfront in the prospectus and policy documents. Insurance companies should provide adequate information on their health insurance products on their websites.
“Policy-holders shall be given an option to seek a change of TPA which could be exercised 30 days before the renewal date of the policy. Such changed TPA would be allocated by the insurer from amongst TPAs empanelled by the insurer for this purpose,” the circular said.
Effective from July 1, companies must reimburse a minimum of 50% of the cost incurred by the insured in pre-insurance medical examination, in cases where the risk is acceptable. “Insurers will also enlist (or empanel, as the case may be) government medical institutions from which such pre-insurance reports will be accepted by them. Where the risk is accepted, copies of such medical examination reports should also be made available to the insured if requested for,” the circular said.
The circular also says that companies may face penalty if they fail to issue identity cards to policy-holders within 30 days from issue of policy.