- Policyholders have 30 days to return policies if dissatisfied.
- Cashless treatment authorization must be completed within 3 hours.
- Physical copies of policies available upon request.
NEW DELHI (Economy India): The Insurance Regulatory and Development Authority of India (IRDAI) has issued a new master circular aimed at enhancing transparency and safeguarding policyholders’ rights. This update outlines key changes in insurance practices, including the return of policies, documentation, and the processing of claims.
1. Availability of Physical Policy Copies
Insurance policies will primarily be issued electronically. However, policyholders can request a physical copy if desired. This request must be specified in the proposal form. Insurance companies are required to provide physical copies if requested.
2. Life Insurance Policy Guidelines
- Issuance Timeline: Insurance companies must issue a policy within 15 days of receiving the proposal form. Initial premiums cannot be collected unless the policy is issued immediately.
- Documents Provided: Each policy will include a covering letter, a copy of the proposal form, a benefit illustration, and a Customer Information Sheet (CIS).
- CIS Details: The CIS will provide information on whether the policy is term or whole life, claim amounts, claim filing procedures, detailed coverage information, exclusions, customer support details, grievance redressal methods, insurance ombudsman details, and renewal dates.
3. Policy Return Options
Policyholders are entitled to a 30-day free-look period during which they can review the policy terms. If they find the terms or coverage unsatisfactory, they can return the policy within this period.
4. Death Claims Processing
- Non-Investigation Cases: Claims that do not require investigation will be settled within 15 days.
- Investigation Cases: Claims needing investigation will be processed within 45 days.
- Nominee Requirement: A nominee is essential for processing death claims.
5. Health Insurance Guidelines
- Cashless Treatment: Cashless claim applications must be processed within 3 hours. Authorization decisions should be made within 1 hour of receiving the application.
- Final Authorization: Final authorization for discharge should be provided within 3 hours of receiving the application from the hospital. Any delays will result in the insurance company covering additional costs incurred.
- Hospital Death: Claims related to death occurring in the hospital will be processed immediately, and the body will be handed over to relatives without delay.
- Multiple Policies Coverage: Policyholders can file claims under multiple policies. If one policy’s coverage is insufficient, additional policies will automatically activate to cover the remaining expenses.
The new master circular from IRDAI aims to streamline insurance processes, enhance transparency, and protect policyholders’ interests. These updates are designed to improve service and ensure timely processing of insurance claims across the country.
Economy India
