Health Insurance Police new 8-year rule by Irdai: All you need to know
New Delhi : Health Insurance companies will not be allowed to contest claims once the end-user has paid a premium for continuous 8 years, Irdai announced as a fresh guideline.
"All policy contracts of the existing health insurance products that are not in compliance with these guidelines shall be modified as and when they are due for renewal from April 1, 2021 onwards.
"After completion of eight continuous years under the policy no look back to be applied...After expiry of moratorium period (of eight years) no health insurance claim shall be contestable except for proven fraud and permanent exclusions specified in the policy contract," Insurance Regulatory and Development Authority (Irdai) said.
The policies will, however, be subject to all limits, sub-limits, co-payments, deductibles as per the policy contract.
On claim settlement, Irdai said the insurance company should settle or reject a claim, as the case may be, within 30 days from the date of receipt of last necessary document.
In case the settlement gets delayed for any reason, the insurance company would be liable to pay interest to the policy holder. It will be asked to pay 2% above the bank rate.
It also said the policy will become void and all premium paid will be forfeited to the company in the event of misrepresentation, misdescription or non-disclosure of any material fact by the policyholder.
It also mentioned that the policies will be allowed for portability. the guidelines said the insured person will have the option to port the policy to other insurers by applying to such insurer to port the entire policy along with all the members of the family, if any, at least 45 days before, but not earlier than 60 days from the policy renewal date.
If such person is presently covered and has been continuously covered without any lapses under any health insurance policy with an Indian general/ health insurer, the proposed insured person will get the accrued continuity benefits in waiting periods.