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IRDAI helps bring customer-centricity in health insurance products

There was a lack of uniformity across insurance plans, and IRDAI is trying to correct that by bringing in standardisation.

April 20, 2020 2:55:18 pm
COVID-19 effect: Premium for health insurance set to rise by up to 25% The regulator truly believes that it is important for the insurers to rightly explain the real purpose of health insurance and the types of coverage to those making a purchase decision. (Representational image, source: Getty Images)

Written by Amit Chhabra

Customers in today’s digital age expect insurers to deliver products and services that meet the standard set by numerous digital giants. What today’s customer looks for is shorter response times, seamless interactions, simple, understandable, and personalized products and more transparency and fairness. There was a lack of uniformity across insurance plans, and IRDAI is trying to correct that by bringing in standardisation. In order to guard against losing the trust and faith of the customers, the Insurance Regulatory and Development Authority of India (IRDAI) has stepped in to make health insurance products more customer-centric. In a series of guidelines issued last year, the regulator advised specialised health and general insurers to make several changes in their offered health insurance products and services so that they can benefit the customers in maximum ways.

The regulator truly believes that it is important for the insurers to rightly explain the real purpose of health insurance and the types of coverage to those making a purchase decision. With radical changes in customer expectations and low tolerance level of the customers, what becomes the turning point for an insurer is the experience it consistently delivers to the customers. As per IRDAI, in the past few years, health insurance covers have surged significantly with the premiums growing from Rs 741 crore in 2001-02 to Rs 37,000 crore in 2017-18. Moreover, the health insurance industry is expected to continue to go up at a rate of 24-25 per cent for the next 5-6 years and is projected to touch 100,000 crore mark by the end of the year 2022. With such a huge demand for health insurance in the market, it is important that the customer is fully aware of what he is buying and the products being offered must revolve around their needs. A panel constituted by the IRDAI has proposed several important changes to the existing health insurance exclusion rules. The changes are proposed in the waiting period of the policy, inclusion of various diseases which were earlier excluded from the policy and inclusion of advanced medical treatments.

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The regulatory body, keeping the needs of customers in mind has guided all insurers to completely standardise all the exclusions in a health insurance cover in accordance with the policy terms and conditions. As per the new guidelines issued by the IRDAI, any disease/s or ailment/s that is/are diagnosed by a physician 48 months prior to the issuance of the health cover will be classified under pre-existing disease (PED). Also, any disease/s or ailment/s for which any type of medical advice or treatment was recommended by a qualified doctor 48 months prior to the issuance of the policy will also be qualified under PED. Apart from this, any condition whose symptoms or signs have resulted within three months of the issuance of the policy will also be classified under Pre-existing Diseases. For customers, this means that going forwards ailments for which they were denied cover by the insurers earlier will now be covered post serving a defined waiting period.

The regulator through its offered guidelines brought into the notice of the insurers that any health conditions and illnesses acquired after the issuance of policy will be covered under the policy. Some of the important and major diseases that must be added to the list include Alzheimer, Parkinson, AIDS/HIV and morbid obesity. In a separate set of guidelines issued by the IRDAI, the regulator has made it compulsory that all insurers will now even provide adequate coverage under a health insurance plan for ailments contracted due to hazardous activity, treatment of mental illness, artificial life maintenance, age-related degeneration and internal congenital diseases. Some other important ailments for which customers will now be able to take treatment through their health insurance include behaviour and neurodevelopment disorders, puberty and menopause-related disorders, genetic diseases and disorders. Catering to the needs of senior citizens and aged individuals, insurers have also been advised to provide coverage for age-related ailments including cataract surgery and knee-cap replacements under a regular health insurance plan. Similarly, factory workers and those working with harmful chemicals – which impact health over a long-term period – who were earlier denied health insurance will now be able to enjoy the benefits of a health cover.

Also Read | Do you need Rs 1 crore health insurance cover?

Further, in order to promote awareness around mental health and help people suffering from mental illness avail best treatment possible, the regulator has asked all health insurers to provide adequate coverage for mental illnesses and related ailments in the regular health insurance policy. For the benefit of the customers, the insurers cannot deny coverage to policyholders who have used opioids or anti-depressants in the past. People with a proven history of clinical depression, personality or neurodegenerative disorders, sociopathy and psychopathy will now be able to take treatment under their health insurance policy. In line with the advisory issued by the IRDAI, insurers have already started customizing products that cater to the specific needs of people suffering from mental illnesses.

Another great relief for the policyholders is that going forward insurers will not be able to reject the claims of the policyholders on the grounds of non-disclosure of any ailment. However, this will only be applicable after eight years of continuous renewals by the policyholder. The panel believes that this move will certainly ease policyholder’s concerns about rejection of claim even after years of paying set premiums. However, the policy would be entirely subject to all clauses including sub-limits, co-pay and deductibles as mentioned in the policy contract.

The regulator – by implementing all the above-mentioned guidelines – aims at improving service standards in the health insurance sector, thereby broadening the scope of coverage and making the health insurance buying process easier for the customers. In order to align their products with the guidelines defined by the IRDAI, the insurers have started to revamp their products so that the products can be refiled at a revised pricing as the number of ailments being covered under a health plan goes up significantly. The revamped products, apart from being in-line with the guidelines issued by the IRDAI, will also focus on all-round wellness of policyholders. However, the customers may witness a surge of 5 per cent in the pricing of health products once the revamped products are launched.

The author is the Head- Health Insurance at Views expressed are the author’s.

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