The Insurance Regulatory and Development Authority of India (IRDAI) has recently implemented significant changes in the health insurance sector, aiming to enhance policyholder empowerment and streamline various processes. Leveraging advancements in insurance technology and collaboration with insurance technology providers, these updates are set to revolutionize the industry. Here’s a detailed look at the top 10 changes you must be aware of if you’re planning to buy health insurance.
- Simplified Renewal Process
With the help of insurance technology, insurers are now prohibited from denying policy renewals solely because of past claims. Additionally, they cannot conduct fresh underwriting unless you request increased coverage. This shift, driven by insurance technology providers, ensures a smoother and more straightforward renewal process for policyholders.
- Compliance with Ombudsman Decisions
Insurance companies must now comply with the orders of the insurance ombudsman within 30 days. Failure to do so will result in penal interest and a daily fine of ₹5,000 payable to the policyholder. Insurance technology helps track and enforce these decisions, ensuring timely compliance and enhancing policyholder trust.
- Inclusive Insurance Products
Insurers are mandated to offer products catering to all age groups, individuals with pre-existing conditions, and disabled individuals. These policies must cover outpatient department (OPD) treatments, daycare treatments, and home care treatments. While such comprehensive coverage can be costly, insurance technology providers are working on innovative solutions to make these policies more affordable and accessible.
- Accelerated Cashless Claims Processing
Starting July 1, 2024, health insurance companies must decide on cashless treatment requests within one hour, thanks to advanced insurance technology. This change addresses inconsistencies in the current system, where different insurers have varying timelines for processing these requests.
- Faster Claim Settlement at Discharge
Insurance companies are now required to approve the final cashless authorization at discharge within three hours of receiving the bills. If there’s any delay beyond this window, the insurer will bear any additional charges from the hospital. This improvement, facilitated by insurance technology, aims to reduce waiting times and provide quicker resolutions for policyholders.
- Simplified Policy Information
Insurers must provide a Customer Information Sheet (CIS) that outlines the essential terms and conditions of the policy in simple language. This initiative, supported by insurance technology providers, aims to make it easier for policyholders to understand their insurance coverage and make informed decisions.
- Transparent Claim Rejection Process
Claim rejections must now be reviewed by a three-member group from the product management committee rather than a single individual. This change, enhanced by insurance technology, ensures greater transparency and prevents arbitrary claim rejections, giving customers more confidence in the fairness of the process.
- Protection Against Claim Rejection After 5 Years
After 60 months of continuous coverage, insurers cannot reject claims for arbitrary reasons unless they can prove fraud by the policyholder. This provision, enabled by insurance technology, provides more security and confidence to policyholders, ensuring the validity of their claims is upheld.
- Rewards for Claim-Free Years
The IRDAI is introducing changes to offer policyholders a choice between increased coverage or reduced premiums upon renewal for claim-free years. Insurance technology providers play a crucial role in implementing these options, particularly benefiting individuals facing higher premiums post-COVID-19.
- Reduced Cancellation Charges
Policyholders can now cancel their health insurance by providing a seven-day notice, with the insurer refunding a portion of the premium for the remaining policy period, provided no claims have been made. Previously, cancellation charges were significantly higher, making it costly to terminate a policy early. Insurance technology ensures smooth processing and accurate refund calculations, making policy management more efficient.
The recent changes introduced by IRDAI, supported by advancements in insurance technology and collaboration with insurance technology providers, mark a significant step towards enhancing the overall insurance experience for policyholders. These changes include faster cashless claim processing, reduced cancellation charges, increased transparency in claim rejection processes, and a focus on simplifying policy information.
Moreover, the emphasis on providing insurance for all, regardless of age or pre-existing conditions, along with coverage for advanced surgeries, demonstrates a commitment to making insurance more inclusive and accessible. While challenges such as pricing for comprehensive coverage remain, these changes are a positive development towards achieving the goal of “Insurance for All” by 2047. Leveraging insurance technology will be crucial in overcoming these challenges and ensuring a more efficient, transparent, and inclusive insurance landscape.
