Uniform health cover terms on the cards

Mumbai: Soon, if your insurer delays settling your health insurance claim beyond 30 days from the date of submitting the last necessary document, it shall be liable to pay penal interest at 2 per cent above the bank rate.  In case of multiple policies taken by an insured person, he shall have the right to settlement of claim from any of the policies. But no health insurance claim would be contestable after completion of eight years.

In order to bring in uniformity in the wordings of health insurance policy contracts, the insurance regulator on Saturday released draft guidelines to standardise around 18 general clauses, such as claim settlement, complete discharge, multiple policies, cancellation, renewal of policy, free look period, fraud, migration and portability that are commonly incorporated in the health insurance policy contracts of indemnity-based health products.

“The objective of these guidelines is to standardise the common general clauses incorporated in indemnity based health insurance (excluding personal accident and domestic / overseas travel) products covering hospitalisation, domiciliary hospitalization and day care treatment in order to simplify the wordings of general clauses in the policy contracts and ensure uniformity and greater transparency,” said the Insurance Regulatory and Development Author-ity of India (Irdai).

All stakeholders have been asked to submit their comments/suggestions on the proposed guidelines by January 25.

On multiple polcies, the draft norms says, “In case of multiple policies taken by an insured person during a period from one or more insurers to indemnify treatment costs, the insured shall have the right to require a settlement of his/her claim in terms of any of his/her policies. The insured person having multiple policies shall also have the right to prefer claims under this policy for the amounts disallowed under any other policy/ policies even if the sum insured is not exhausted. Then the insurer(s) shall independently settle the claim subject to the terms and conditions.

“If the amount to be claimed exceeds the sum insured under a single policy, the insured person shall have the right to choose insurer from whom he/she wants to claim the balance amount. Where an insured person has policies from more than one insurer to cover the same risk on indemnity basis, the insured person shall only be indemnified the hospitalistion costs in accordance with the terms and conditions of the chosen policy.”