IRDAI – Landmark Reforms in Health Insurance – Master Circular dated 29.5.2024
IRDAI has issued Master Circular dated 29.5.2024 of 17 pages on its Insurance Products Regulations 2024 – Health Insurance
This Master Circular has repealed 55 earlier circulars. It is aimed at healthier insurance landscape since it has brought the entitlements at one place for ready reference and also to provide seamless, faster and hassle-free claims.
It is provided that the existing products not complying with Regulations of 2024 and the Master Circular dated 29.5.2024 shall be modified on or before 30.9.2024.
The salient features of the Master Circular for Policy holders / prospects / customers are – wider choice with flexibility to choose products / add-ons / riders and customer information sheet
In case no claims during policy period, the insurers may reward the policy holders by providing an option to choose such NO CLAIM BONUS either by increasing the sum insured or discounting the premium amount.
Master Circular requires the Insurer to decide on cashless authorization requests immediately and within one hour and final authorization on discharge from hospital within three hours of request from the hospital.
Strive towards achieving facilitation of 100% cashless claim settlement in a time bound manner.
Insurer is liable to pay Rs.5000 per day to the policy holder in case Ombudsman Award is not implemented in 30 days.
As rightly said in the Press Release, the Master Circular is landmark to empower the policy holders for highest standards of care and service as also environment of trust and transparency in the health insurance sector.
No claim can be repudiated without the approval of the Claims Review Committee which is required to take decision on repudiation of every claims.
