IRDAI vide Circular bearing reference no: IRDAI/HLT/CIR/PRO/84/5/2024 dated May 29, 2024, issued Master Circular on IRDAI (Insurance Products) Regulations 2024 – Health Insurance (“ Health Products Master Circular 2024 ”). The Health Products Master Circular 2024 shall apply to all Insurers (General, Health and Life) in India.
Major highlights of the Master Circular are as follows:
- 1. General Information for the Policy Holders/Prospect/Customers: Insurers shall comply with the requirements and conditions specified in Chapter I of the Health Products Master Circular 2024, which are as follows:
- a. Availability of Products/add-ons/riders to all categories
- b. Technological Advancement & Treatment
- c. Compliance With Medical Laws
- d. Customer Information Sheet (CIS)
- e. Insurers shall provide a free look period of 30 days (from the date of receipt of the policy document) to every policyholder to review the terms and conditions of the policy.
- f. Cancellation of indemnity-based health insurance policy
- g. Insurers shall put in place a simple and seamless procedure for registering and changing nominations in the policy.
- h. Grace Period for payment of premium
Premium paid
Grace Period
Premium is paid in monthly instalments
15 days
Premium is paid in quarterly/half-yearly/annual instalments
30 days
If the policy is renewed during grace period, all the credits (sum insured, No Claim Bonus, Specific Waiting periods, waiting periods for pre-existing diseases, Moratorium period etc.) accrued under the policy shall be protected. The same is applicable for both Indemnity and Benefit products.
- i. Availability of insurance coverage during the grace period
- j. Requirements with respect to Renewal of Health Insurance Policy.
- k. Migration process in case of indemnity policies
- l. Requirements concerning profitability in case of Indemnity Policies
- m. Requirements with respect to Policy/Claim cannot be contested
- n. Criteria for no claim bonus
- o. Process for Approval for Cashless facilities
- p. Requirements concerning final authorisation for Discharge from the hospital.
- q. Conditions and requirements with respect to Settlement of claims
- r. Requirements concerning claims in respect of multiple policies held by the Policyholders
- s. Requirements with respect to the Grievance Redressal Mechanism for policyholders.
- t. Requirements relating to implementation of Ombudsman Award.
- 2. Requirements to be complied by the Board of Directors of the Insurers in Health Insurance Business: Insurers shall comply with principles specified in Chapter II of the Health Products Master Circular 2024, which shall include the following:
- a. Board Approved Underwriting Policy: Insurers shall have a well-documented Board Approved Underwriting policy covering all the aspects specified in the Chapter II of the Health Products Master Circular 2024 and IRDAI (Insurance Products) Regulations, 2024.
- b. Board Approved Policy on Quality Standards and Benchmarks for empanelment of Hospitals and Health Care Providers: Insurers shall have a well-documented Board Approved policy on Quality Standards and Benchmarks for empanelment of Hospitals and Health Care Providers which enables the empanelment of all the categories of hospitals considering the affordability of different segments of the population.
- c. Principles relating to proposal forms/customer information sheet
- d. Process relating to the constitution of the Claims Review Committee, claims handling and Settlement process.
- e. Requirements concerning the Display on Insurers Website
- f. Principles related to training and Combi Products
- g. Principles for the constitution of Product Management Committee, Advertisement Committee.
- h. Principles and procedures with respect to Product Fillings
- i. Procedures related to the withdrawal of Products
- 3. Miscellaneous Provisions: Insurers shall comply with the miscellaneous requirements specified in Chapter III of the Health Products Master Circular 2024, which are as follows:
- a. Provisions related to model products for persons with disabilities(PWD), persons afflicted with HIC/AIDS, and those with mental illness.
- b. Facilitation of Ayushman Bharat Health Account number.
Insurers shall submit periodic returns on Premium, claims etc. as per the provisions of the Master Circular on Submission of returns issued by the Competent Authority.
Source category: IRDAI
Attachments
- /2024/398_Master_Circular_on_Health_Insurance_Business_29052024.pdf
- /2024/398_Annexure_to_Master_circualr_on_Health_Insurance_Business_29052024.pdf
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