What are the new health insurance laws?

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12 Dec 2023

Protective Health Insurance Laws.

The insurance industry in India has private, as well as public sector companies. There is a huge demand for health insurance these days and so the leading insurance providers like Kotak Health Insurance, offer some excellent health insurance covers at some of the most competitive rates. The entire industry is regulated and overseen by the Insurance Regulatory and Development Authority, also known as the IRDAI. The IRDAI implements certain rules and guidelines that all insurance providers must abide by. Read on to know what they are.

IRDAI health insurance guidelines

Listed below are some of the important guidelines that the IRDAI has implemented with respect to health insurance in India:

Terms and conditions

The IRDA has made it compulsory for all health insurance companies to clearly state the terms and conditions regarding the coverage on the policy documents and on the brochure. Before purchasing the plan, the customer should be able to read all the clauses, understand them and then make an informed decision.

Validity

If the policyholder has diligently paid the premium on time, year after year, then the insurance provider cannot ask him to exit the plan at any time.

Migration option

In the case of coverage ending (due to factors such as a child becoming an adult, a pregnant woman after delivery, etc), the insurance provider has to offer a migration option to the policyholder. He or she should be able to shift to another coverage and continue to stay under the health insurance umbrella.

Justification for rejection of application

Any insurer rejecting a health insurance application has to give a proper and detailed justification to the customer about my being rejected. Simply stating the application is rejected will not suffice.

Premium amount

The premium amount of all health insurance plans needs to be justifiable and within affordable limits. The IRDA regulates the price of all health plans sold in India, ensuring that the customers are not overcharged.

No claim rejection after 8 years

The insurance provider cannot reject any claim if the policyholder has paid the premium for 8 years on time, without any gap or failure. This 8-year tenure is known as the moratorium period in health insurance and anyone who completes it is eligible to get a health insurance claim. The insurance provider can only reject it if there is any illegal or fake claim being made.

Delay in claim settlement

The insurer cannot delay a claim payout beyond 45 days. If this happens, the insurance provider is liable to pay the policyholder an interest of 2% on the overall claim settlement amount above the bank rate for the delay.

There are many other laws that make health insurance safe and transparent in India, so you can go ahead and get a plan without any worry.

The final word

The IRDA health insurance laws and guidelines are quite comprehensive and keep the interests of the policyholder well protected. If you are buying health insurance currently, ensure you do so from an insurer that complies with the IRDA rules and offers the best coverage.

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Dos & donts while purchasing medical insurance policy


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Team Kotak GIC

The content of this blog has been created and carefully reviewed by the esteemed team at Kotak General Insurance, with the sole purpose of providing valuable guidance and sharing insights on the importance of general insurance. Our objective is to assist users in making informed decisions when purchasing or renewing insurance policies for their cars, bikes, and health. Our expertly curated information aims to empower our readers with the knowledge they need to protect their valuable assets and financial interests.