As per a recent Forbes?report,?nearly 40 crore individuals in India have zero access to health insurance. This figure in itself shows the low penetration of health insurance in our country, for which the complexity of health insurance?policies in India is a big reason.
That is why India's insurance regulator, IRDAI (Insurance Regulatory and Development Authority of India), is coming up with revised guidelines aimed at simplifying health insurance.
IRDAI has asked?insurance companies to provide updated customer information sheets (CIS)?for highlighting all key policy details in simple terms from January 1, 2024. From the type of policy to coverage details to waiting period to limit and sub-limits to exclusions to free-look period to portability to guidance on procedure for claim submission and contact details for filing complaints will be available "in simple language in a snapshot" in the customer information sheet, the insurance regulator said in a press release on October 30, 2023, as per the ET report.
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For the unversed, a?customer information sheet, or CIS, gives you a glance at the key policy details in a summarised format. Usually, the insurer provides a customer information sheet with the policy at the time of purchase and renewal of the policy.??
The new format of the customer information sheet will help policyholders understand the complex terms and procedures related to their health insurance policies better.?IRDAI said, "This step is expected to result in better-informed policyholders, reduced disputes and delays, and a seamless health insurance experience for policyholders."
Typically, the health insurance policy document is rather lengthy, and policyholders must carefully examine crucial information. With this overhauled customer information sheet, policyholders will be able to obtain facts like exclusions, waiting periods, financial limits of coverage, and claim procedures in very simple words, said Rakesh Goyal, Director of Probus Insurance Broker.
The new CIS further breaks down the complex terms of a?health insurance policy, including sub-limits, all exclusions, and migrations, and mentions them in?straightforward language, barring jargon or technical terms, said experts, as per the ET report.
"It's crucial for policyholders to have a complete understanding of the terms and conditions of their insurance coverage. With the revised customer information sheet (CIS) now in place, policyholders will have easy access to vital information, such as the sum assured, policy coverage, exclusions, claims procedure, and more. This development not only enhances transparency but also empowers policyholders to make informed decisions about their insurance needs," said Dhirendra Mahyavanshi, CEO and co-founder of Turtlemint, an insurtech platform.
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The customer information sheet is designed to provide policyholders with all important information about their health insurance policy in simple language in a snapshot, which includes the following:?among others:
a) Name and type of policy
b) Coverage details
c) Waiting periods
d) Limits and sub-limits
All exclusions:
f) Concepts like?
i. free look cancellation
ii. migration
iii. portability
iv. moratorium period
g) Guidance on the procedure for claims submission
h) Contact details/web links for grievance/complaint filing
"Additionally, it will also highlight the obligations of policyholders to make transparent and fair disclosures of relevant material information about their health, as non-disclosure of the same may affect the claim settlement," the insurance regulator said.?
IRDAI has also asked insurers to ensure following compliances while issuing the CIS:?
a) Insurers, intermediaries, and agents should distribute the updated CIS to all policyholders, ensuring physically or digitally documented confirmation.?
b) If a policyholder wants, the CIS should be made available in his or her local language.?
c) The font size on the CIS must be a minimum of 12 (Arial) or bigger.?
d) All details provided for in the CIS should be duly filled in.?
e) The forwarding letter for the policy document should contain a reference to the CIS.
Further, the insurers are also required to obtain signatures of the policyholders confirming that they have noted the details of CIS and received it, IRDAI added.?
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