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Settling Health Insurance claim from multiple insurers: Here’s some good news for you

Rajeev Kumar
Health Insurance Regulations

Health Insurance Regulations 2019: The Insurance Regulatory and Development Authority of India recently notified the Insurance Regulatory and Development Authority of India (Health Insurance) (Amendment) Regulations, 2019. It has introduced several new provisions, including a call to the insurers to promote wellness amongst the policyholders as per the guidelines of the authority from time to time. "Insurers may endeavour promoting wellness amongst policyholders of health insurance as per the guidelines as may be specified by the Authority from time to time," says one of the provisions in the notification.

There are a few more subscriber-friendly changes in the regulations. Here we take a look at two of them and what they mean for the insured persons:

1. Clause l of the notification says: "For clause (2) of sub-regulation (ii) of regulation 24, the following clause shall be substituted, namely: – "Balance claim or claims disallowed under the earlier chosen policy/policies may be made from the other policy/policies even if the sum insured is not exhausted in the earlier chosen policy/policies. The insurer(s) in such cases shall independently settle the claim subject to the terms and conditions of other policy/policies so chosen."

Explaining the significance of this clause for policyholders, Amit Chhabra, Head- Health Insurance, Policybazaar.com, told FE Online that the above is a good option for the customer as they will have the option of settling the claim from multiple insurers on a certain condition.

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"This is a good option for the customer as they have the option of settling the claim from multiple insurers providing the policyholder discloses the existing health insurance covers. This benefit comes in handy in case of multiple policies like if someone has an employer-provided corporate policy along with an individual policy," he said.

2. Clause "k" of the notification says: ". In sub-regulation (i) of regulation 23, the words "The insured shall be informed in writing of any underwriting loading charged as filed and approved under the Product Filing Guidelines over and above the premium and specific consent of the policyholder for such loadings shall be obtained before issuance of a policy. " shall be omitted."

Chhabra said, "Loading means an additional premium charged to the customer because of any prevailing conditions as defined by the insurance company. Loading basically provides cover to a ‘risky’ individual."

He further said that the new provision is good for policyholders as it will give the customer "a lot of clarity on how much coverage they will receive and how much loading amount they will be charged as a part of the premium. This is done only with the consent of the customer."