India: IRDAI proposes to allow greater operating freedom in health insurance business – Asia Insurance Review

The insurance regulator IRDAI is proposing several amendments to the IRDAI (Health Insurance) Regulations, 2016 following a review and after taking into consideration the dynamics of the insurance industry.

In a statement issued earlier this week, the IRDAI says that the 2016 Regulations have been comprehensively reviewed in order to examine the scope for allowing operational freedom to both insurers and TPAs while protecting the interests of policyholders. “The extant regulations are also reviewed from the perspective of allowing further facilitations to the Insurers and the TPAs,” the IRDAI added.

The draft IRDAI (Health Insurance) (Amendment) Regulations, 2022 is open for feedback by stakeholders until 6 March 2022.

Among other purposes, amendments are proposed to a number of clauses which would:

encourage life insurers also to incentivise policyholders for early entry, continued renewals (wherever applicable), favourable claims experience, preventive and wellness habits etc, as applicable. The current Regulations already provide for general insurers and health insurers to devise mechanisms or incentives to reward policyholders in the situations outlined.

encourage insurers to offer discounts where there is an improvement in the risk profile.

provide for personal accident products to be brought under the ambit of lifelong renewability in the interests of policyholders.

omits a clause relating to the handling of the costs of pre-insurance medical examinations. Explaining this proposed amendment, the IRDAI says, “These are operational matters, hence considered to be left to the insurers to decide.”

omit the definition of “Health Services Agreement” as the IRDAI proposes to remove the requirement for written tripartite/bipartite agreements amongst insurers, TPAs and hospitals.

remove existing rules that mandate that agreements be signed by insurers and cashless facility providers. The IRDAI says that the requirement is highly prescriptive. “While shifting the onus of ensuring the availability of a cashless facility at network providers to insurers, it is proposed to leave it to the insurers the manner of engaging the network providers,” the regulator explains.

ensure that after porting a policy, no subsequent claim related to claims already made with the previous insurer shall be repudiated by the new insurer on grounds of non-disclosure.

prescribe timelines for calling for claim details from the previous insurer by the policyholder’s new insurer after porting a policy.

mandate the disclosure on insurers’ websites of the procedure for porting-in an insurance policy, so as to ensure transparency and provide for policyholder education.