IRDAI Issues New Health Insurance Guidelines to Protect the Policyholders

Health insurers will now have to pay penal interest to the insured individual if they are unable to settle claims within 30 days after the last vital document for claim settlement was received.

As per the IRDAI (Insurance Regulatory and Development Authority of India), the insurer will have to pay the interest at 2% above the bank rate which will be calculated from the date of receiving of the last document till the date of payment of a claim.

However, in cases where an investigation is required, the insurer has 45 days to settle them and will have to complete the investigation as soon as possible.

The insurance regulator also says that the policyholders shall have a right for claim settlement on the basis of terms and conditions of the policies in case he/she has multiple health insurance plans. And the insurers are obliged to settle claims at the earliest then.

As the IRDAI says, “Insured person with multiple policies shall also have the right to prefer claims under the policy for the amounts disallowed under any other policy/policies even if the sum insured is not exhausted. Then the insurer(s) shall independently settle the claim subject to the terms and conditions of the policy. When the amount to be claimed exceeds the sum insured under a single policy, the insured person shall have the right to choose an insurer from whom he/she wants to claim the balance amount.”

The guidelines are issued to protect the policyholders by establishing fair practices in health insurance claims. These are sure to make the policyholders of all health insurance companies including Star Health, Religare, ManipalCigna, Universal Sompo, etc. feel more confident about the health insurance claim settlement process.