Proposes Portability In Draft Guidelines IRDA seeks health cover up to 65 years

New Delhi: Sectoral regulator IRDA has proposed to make it mandatory for health insurers to provide policy cover to people up to 65 years and settle all claims within a month. 

    In its draft guidelines for health insurance companies, IRDA said that insurers would have to provide cashless facility to policyholders undergoing treatment in a particular hospital even after it is removed from the list of preferred service providers. 

    These provisions form part of IRDA's exposure draft on Insurance Regulatory and Development Authority (Health Insurance) Regulations 2012. The draft also talks about portability, under which a policy holder can migrate to another health insurance providing company, without losing any benefit. Besides, it has also proposed special provisions for senior citizens whose need for health care is pressing. 

    Under the proposed norms, insurer will have to provide customers all relevant information in a simple language and on a single page. The insurer will be required to provide reasons for denial of claims to insured persons. 

    According to the draft norms, insurers should ensure that empanelled hospitals—where cashless facilities are offered for policyholders—are spread across different cities and not confined only to metros. IRDA has also suggested that insurers should keep policyholders informed on nearest hospital where cashless facility is available. The insurers should also display the updated list of network providers on their websites. 

    "For the purpose of claim settlement, insurer shall make direct payments to the network provider and to the policyholders by integrating their banking system platform with the network provider or the insured, as the case may be," the draft said. The insurers, it said, will also be allowed to come out with 'Health-plus Life Combi' products which would be a combination of life and health insurance cover. AGENCIES 

BOOSTER SHOT 

tInsurance regulator seeks special provisions for senior citizens 

tDraft guidelines call on insurers to provide all information on a single page in simple language 

tIRDA also wants to make health insurers settle all claims within a month tSeeks provision of cashless facility to policyholders in a hospital even after it is removed from list of preferred service providers 

tSays insurers should ensure listed hospitals are spread across different cities and not just to metros