health insurance claim settlement: New health insurance rule in 2024: CIS will show claim settlement time, other key policy details from January 1

To make it easier for policyholders to understand critical aspects of their health insurance policies, insurance companies have been asked to provide revised customer information sheets (CIS) highlighting all key policy details in simple terms. From type of policy to coverage details to waiting period to limits and sub-limits to exclusions to free-look period to portability to guidance on the procedure for claims submission to turn around time for settling the claims to contact details for filing complaints — all will be available “in simple language in a snapshot” in the customer information sheet in the preferred language of the policyholders.

What is a customer information sheet (CIS) of a health insurance policy?

A customer information sheet or CIS gives you a glance at the key policy details in a summarized format. Usually, the insurer provides a customer information sheet with the policy at the time of purchase and renewal of the policy. The new format of the customer information sheet will help the policyholders understand the complex terms and procedures related to their health insurance policies better.

How new customer information sheet of your health insurance policy will look from January 1, 2024

According to a format prescribed by the Insurance Regulatory and Development Authority of India (IRDAI), your CIS will have the following details

1) Name of the insurance policy
2) Policy number
3) Type of insurance product: Indemnity, benefit, or both indemnity and benefit.
4) Sum insured (basis): The amount will be mentioned here.
5) Policy coverage: What your health insurance policy covers.
6) Exclusion: What your health insurance policy does not cover.
7) Waiting periods
8) Financial limits: Sub-limits, co-payments, deductibles, and any other limits as applicable.
9) Claim procedure: Turn around time for claims settlement for i) pre-authorization of the cashless facility, ii) cashless final bill authorization.
The details of online links of the following will be mentioned:
i) Network hospital details
ii) Helpline number
iii) Hospitals which are blacklisted or from where no claims will be accepted by the insurer.
10) Policy servicing: i) Call center number of the insurer; ii) Details of official company
11) Contact details/web links for grievance/complaint filing
12) Things to remember:
i) Free-look period
ii) Renewal policy
iii) Migration and portability
iv) Change in sum insured
v) Moratorium period
13) Your obligation: You need to disclose all pre-existing diseases or conditions before purchasing the policy. Non-disclosure of pre-existing conditions may affect your claim settlement later.

Additionally, it will also highlight the policy clause numbers for each of the above-mentioned fields (where it is applicable) to make the policy more transparent to the customer.

Further, the insurers are also required to obtain signatures of the policyholders confirming that they have noted the details of CIS and received it, IRDAI mentioned earlier.

How will this updated CIS benefit the health insurance policyholders?

Typically, the health insurance policy document is very lengthy, and has very complex wording which makes it very cumbersome for most policyholders to carefully examine crucial information. The updated CIS or customer information sheet, will provide policyholders with a quick, convenient guide about their policies, said many industry leaders. “This initiative addresses a longstanding challenge for policyholders – deciphering the complexities of their coverage. On average, a standard health insurance policy document has 10,000+ words with a reading time of 1 hour and 15 mins, and a reading comprehension score so low that it should be difficult for most English-speaking adults to even understand With the proposed CIS, insurers are mandated to communicate policy details clearly and concisely, ensuring transparency. Notably, the inclusion of claim settlement timeframes is a significant improvement, setting expectations for policyholders, ” says Abhishek Poddar, Co-founder and CEO, of Plum.

“A simpler CIS will reduce the complexities, policyholders find while dealing with their service experience. This step is expected to result in better-informed policyholders, reduced grievances, higher renewals, and seamless health insurance experience for policyholders,” says Anand Singhi, Chief Distribution Officer, Reliance General Insurance Company Limited.

“The new CIS will also provide a hassle-free experience at the time of hospitalization, as they will not have to deal with voluminous policy documentation. Additionally, this simple-to-follow and uniformly formatted customer information sheet will help policyholders understand policy clauses , any restrictions, sub-limits, claim procedures, and requirements with sheer ease. In case the policyholder does not have time to go through the detailed policy document, they can study the policy summary carefully via CIS,” says Siddharth Singhal, Business Head. , Health Insurance, Policybazaar.com.

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