The Insurance Regulatory and Development Authority of India (IRDAI) introduced some customer-friendly changes in health insurance policies amid the coronavirus pandemic. All of the following changes have become effective.
1. COVID-19 specific standard policies
In July, insurance companies started offering two standard COVID-19 health insurance policies called 'Corona Kavach' and 'Corona Rakshak' at the orders of IRDAI. These policies cover all hospitalisation expenses arising from coronavirus, along with provisions for pre and post hospitalisation expenses. These are sold as 'Corona Kavach' and 'Corona Rakshak', followed by the name of the insurance company.
2. Digital verification
Health insurers can now validate health insurance policy proposals forms through digital means in place of physical signatures. Policyholders are allowed to validate their insurance agreement via a one-time-password (OTP), without using a physical signature on the hard copy of the proposal form.
3. Paying premiums in installments
After the COVID-19 outbreak, IRDAI allowed payment of health insurance premiums in instalments, that is, the frequency of premium payment could now be monthly, quarterly or half-yearly and annually. The decision to offer the facility rests in the hands of the insurers.
4. Pre-Existing Diseases Definition
As per IRDAI's guidelines, any disease/s or ailment/s diagnosed by a physician 48 months before the issuance of the health cover will be classified under Pre-Existing Disease. Also, any disease/s or ailment/s for which any type of medical advice or treatment was recommended by a qualified doctor 48 months before the issuance of the policy will also be qualified under PED.
Further, any condition whose symptoms or signs have resulted within three months of the issuance of the policy will be classified under PED.
IRDAI has issued a list of ailments and diseases, excluding which no other exclusions will be allowed.
The regulator has mandated that insurers include permanent exclusions only after due consent of the customers, to ensure that those with PED get adequate health cover.
The IRDAI has asked insurers to include telemedicine under the health insurance policy. This means that anyone taking telemedicine consultation from a doctor will be allowed to claim the expenses under a health insurance policy, provided their policy covers OPD expenses.
6. Rewarding Policyholders for prevention
Insurance companies now include wellness and preventive features in health policies that encourage policyholders to stay healthy and minimize the chance of falling sick. Insurers may offer reward points to those policyholders who comply with or meet the set criteria of wellness and preventive features.
7. New ailments covered
The IRDAI has issued guidelines that named various illnesses to be covered in a regular health insurance policy. Treatment for mental illness, age-related degeneration, internal congenital diseases and artificial life maintenance will be covered under a comprehensive health insurance plan. These include behaviour and neurodevelopment disorders, genetic diseases/disorder, cataract surgery, knee-cap replacements and cover for puberty and menopause-related disorder.
Exclusions have also been standardised which means that if an insurer does not want to cover some diseases like AIDS or chronic kidney diseases, the insurer will have to specify as defined under guidelines, in the policy terms.
Specifications on waiting period before the coverage becomes applicable will also have to be made.
8. Long term policyholders' claims not contestable
Health insurers will not be allowed to contest claims once the premium has been paid for a continuous period of eight years, except for proven fraud and permanent exclusions specified in the policy contract.
IRDAI said the objective of the guidelines is to standardise the general terms and clauses incorporated in indemnity based health insurance (excluding personal accident and domestic/overseas travel) products by simplifying the wordings of general terms and clauses of the policy contracts and ensure uniformity across the industry.
Policy contracts of the existing health insurance products that are not in compliance with these guidelines shall be modified as and when they are due for renewal from 1 April 2021 onwards.