IRDAI notified to Insurers on Health Insurance Scheme Regulations on 29th May, 2024. What are the key features of the said Regulations ?

On 29th May, 2024, Insurance Regulatory and Development Authority of India (IRDAI) notified the Master Circular on IRDAI (Insurance Products) Regulations 2024-Health Insurance. This master Circular was effective with immediate effect i.e., 29th May 2024. This Circular is subdivided into 3 Chapters as under: Chapter I talks about General Information for the Policy Holder / Prospect / Customer. Chapter II talks about Broad Requirements to be complied with by the Insurer for offering Health Insurance Business. Chapter III talks about some miscellaneous provisions related to submission of returns, model policy for persons with disability / HIV. Key Features: Customisation in Policies and Products: Now Customers have options for a greater range of products and add-ons to protect assets, risks, and liabilities from various situations. This further enhances the flexibility and provides greater product options to best cater varied customer needs. Customer Information Sheet (CIS): This sheet would provide easy-to-understand policy details, exclusions, warranties, and claim settlement procedures, comprising coverage scope, etc. to ensure transparency and provide greater clarity for policyholders. Simplified Claim Procedure: Claims cannot be dismissed because of any deficiency in the documents. Documents will be requested during underwriting, and only will be required for claim settlement if cashless options are not available. Product Cancellation: Consumers have an option to cancel their insurance policies at any time by notifying the insurer. On the other hand, Insurers can only cancel plans if fraud is proven, with proportionate premiums refunded for the remaining period. After the Moratorium Period, which is 60 months of continuous coverage, health insurance policies and claims cannot be challenged for non-disclosure or misrepresentation until proven fraudulent. Grievance Redressal Mechanism: Insurers shall setup a robust grievance redressal mechanism in place to address all their customer concerns. Further, Details like the insurance ombudsman's contact details, where the grievance can be escalated, etc. must be included in the insurer's response letter to any complaints. Submission of Returns: Insurers are required to submit periodic returns on Premium, claims etc. as per the provisions of the master circular on submission of returns issued by the Competent Authority.