Health cover can’t be denied till 65

FC 26/5/09

Come July 1, 2009, health insurance providers will be more accountable while dealing with senior citizens. In an order issued on Monday, the Insurance Regulatory and Development Authority (Irda) has directed all insurers to provide health covers to senior citizens at least till 65 years of age, if sought.

At present, many insurers deny health insurance covers to people on the basis of age, with some companies placing the ceiling at 45 years and others at a slightly higher age of 55. The order comes in pursuance of the recommendations of various committees and working groups constituted by the insurance regulator.

Irda has also asked the health insurance companies to charge premium fairly from senior citizens. “The charges should be fair, justified, transparent and duly disclosed upfront. The details of any loading charges must also be available to the insured. Insurers should devise a mechanism to reward policyholders for early entry and continued renewals with the same insurer,” Irda chairman J Hari Narayan said.

The Irda order also said that in case of denial of insurance cover to senior citizens, the insurers must record and furnish the reasons for the same.

“The reason should be recorded and furnished in writing. Such reasons should stand scrutiny of reasonableness and fairness. Also, any difference in product specifications for different age groups or for different ages must be clearly spelt out upfront in the prospectus and policy documents,” the Irda order said.

The circular shall take effect for all policies issued or renewed on or after July 1, 2009. From July1, 2009, all health insurance policies will have to enclose an annexure briefly describing in simple language the coverage and key terms and conditions of the policy. Each instance of delay in issuance of identity cards to policyholders beyond 30 days from the issue of a policy may entail a penalty.

Irda has also asked insurance companies to give an option to policyholders to change TPAs (third party administrators). “Where TPAs are used by insurers, policy holders shall be given an option to seek a change of TPAs, which could be exercised 30 days before the renewal date of the policy and such changed TPAs would be allocated by the insurer from among the TPAs empanelled by the insurer for this purpose,” the Irda order said.

It also said that insurers will ensure data collation and timely compliance in providing product-wise reports as and when required by Irda, providing information on the number of persons insured, claims, distribution, claim settlement etc.

Insurers have also been told to reimburse at least 50 per cent of the cost incurred in pre-insurance medical examination in cases where the risk is accepted. In addition, insurers will also enlist (empanel, as the case may be) government medical institutions from which such pre-insurance reports will be accepted.

The insurers will also ensure adequate dissemination of product information on all health insurance products on their websites. The information shall include a description of the product and copies of prospectus, proposal and policy clauses, the Irda order said.

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