The insurance regulator Irda has said all health insurance products filed must allow entry at least till 65 years of age.
In a notification on Monday, Irda has said any difference in product specification for different age groups or for different entry age must be spelled out upfront in the prospectus and policy documents. The Irda has further said that each instance of delay in issue of identity cards to policyholders beyond 30 days from issue of policy may entail a penalty being levied on the concerned insurer.
All health insurance policies must enclose an annexure briefly describing in simple language the coverage and the key terms and conditions of the policy.Insurers will ensure data collation and timely compliance to providing the product-wise reports as and when required by the authority, providing information on the number of persons insured, claims data, distribution and claim settlement.
Insurers will reimburse at least 50% of the cost incurred by the insured in pre-insurance medical examination, in cases where the risk is accepted. In addition, 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 Insurers will ensure adequate dissemination of product information on all their health insurance products in their websites. The information shall include a description of the product, and copies of the prospectus, proposal and policy clauses.
The Insurers will individually and collectively work towards evolving mechanisms for action against medical establishments, TPAs and policyholders guilty of making or supporting fraudulent claims and for sharing of such information among themselves, said Irda.
source: The Financial Express
