With a view to continue the relationship with policyholders and to ensure information flow, the Insurance Regulatory and Development Authority of India ( “IRDAI”) has in a circular dated 1st March, 2021 issued certain norms to ensure flow of relevant information to the policyholders. The directions are applicable to All General and Health Insurers ( except Export Credit Guarantee Corporation of and Agriculture Insurance Company of India , and insurance companies will have to comply with the directions within 1st June, 2021.
The following norms are specified :
1. All the general and health insurers as part of policy servicing, will communicate the following basic information about the health insurance policy to the policyholders:
a. Name of Product and policy number,
b. Extent of coverage available by way of available Sum Insured and Cumulative Bonus,
c. Number of insured people covered under policy,
d. Policy period,
e. Number and amount of claim settled (under relevant period), if any,
f. Balance Sum Insured and Accrued cumulative bonus available, if any,
g. Due date of renewal and premium payment frequency,
h. Premium amount due on renewal (to be specified at the time of renewal)
i. Grace Period (within 5 days after renewal due date)
j. Contact details (for any query or other issues) of customer support service of Insurer, Toll Free No. or e-mail Id etc.
2. The above information will be communicated by insurers to all the policyholders twice in a year, i.e, 6 months after issuance of policy and at least 1 month prior to the renewal due date. However, in case of a multiyear policy, the information can be shared with a frequency of 6 months from the date of issuance of policy.
3. In addition to the above, in the event settlement of any claim under a health insurance policy, the insurer will also communicate the details of balance sum insured along with the cumulative bonus available, if any, to the policyholder. This shall be notified to the policyholders within 15 days of settlement of claim.
4. The insurer may choose any mode of communication (message, e-mail, letter etc) for the purpose of notifying the above referred information. The sample messages / communications that all the insurers to notify to the policyholders is placed at Annexure-1 for illustration purpose only. Insurers can improve on the same while refraining from making the message complex, unintelligible or too long with unnecessary information. These norms are applicable to all individual (both indemnity and benefit based) health insurance policies.
Source : Insurance Regulatory and Development Authority of India
