IRDAI proposes to make policyholders less accountable while porting health policy

Soon, insurers may be solely responsible for collecting the policyholder’s claims information from the existing insurer after porting of a health policy. As a result, insurers will not be able to deny claims on the grounds of non-disclosure. Also, insurers will have to search the policyholder’s essential medical and claims history from the existing insurer within five working days of receipt of the portability form.

The changes proposed by IRDAI are aimed at making policyholders less accountable while porting their health insurance policies.

Nikhil Kamdar, appointed actuary of Digit Insurance, said as per the proposed guidelines, insurers would be responsible for obtaining the policyholder’s past claims history from the existing insurer. Previously, it was the responsibility of the insured to disclose these details to the new insurer, and future claims could be rejected if such details were not explicitly shared at the time of porting.

“Furthermore, insurers have been advised to publish on their website all information on the policyholder’s responsibilities while porting their policies, apart from the sequence of steps to be followed. The proposed changes may make policyholders less accountable while porting. The insurers have a responsibility as they have to increase due diligence,” Kamdar said.

The guidelines have also prescribed a period of five days from the receipt of the portability form for the port-in insurer to obtain all necessary information from the existing insurer.

Naval Goel, Founder and CEO, said that by making portability a time-bound process, IRDAI aims to ensure that policyholders’ requests are not pending for an undefined period.

“Since portability is quite a common trend in health insurance and it was mainly done manually, which you would consume for at least 15 days or more, this order was quite necessary. During this course, policyholders We were never sure whether they would get a new policy or not and if they did not get health insurance from the new insurer, it would put them in a difficult position. However, this will not happen with these new draft amendments,” Goyal said. said.

In addition, IRDA has also proposed that the insurers should arrange for adequate number of public and private sector network providers across all geographies to provide cashless facility. Goyal said, “The main focus of health insurance is to provide cashless facilities to policyholders in dire situations. However, due to non-availability of network hospitals, policyholders suffer losses. Hence, this mandate further signifies the importance of health insurance and Ensure high reliability of customers’ insurance policies.”

IRDA has proposed these amendments in the regulation in consultation with the Insurance Advisory Committee. The draft is under review and IRDA has asked stakeholders to share their feedback.

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