Taking cognisance of the steep hike in premiums for health insurance for senior citizens, the insurance regulatory and development authority of India (IRDAI) says effective immediately, insurance companies cannot revise the premium for senior citizens by more than 10%pa (per annum).
In a
release, the insurance regulator says, "Unlike in case of Pradhan Mantri Jan Arogya Yojana (PMJAY) scheme where the hospitalisation expenses are negotiated centrally for package rates and are thus standardised across various hospitals, there is no such standardisation in case of health insurance products. This is leading to higher hospitalisation costs resulting in higher claims outgo under health insurance products offered by insurers."
"In this context, the most vulnerable age group is the senior citizens having limited sources of income and this group is impacted the most when there is a steep increase in health insurance premium. This matter has been engaging the attention of IRDAI and is a regulatory concern."
While directing all general and health insurers not to revise premiums for senior citizens by over 10% annually, IRDAI says if the increase is more than 10% or withdrawal of the health insurance product, then the insurer needs to do a prior consultation with the regulator.
Further, IRDAI asked insurers to take necessary steps for the common empanelment of hospitals and negotiate package rates similar to the PMJAY scheme.
As part of the ongoing monitoring of insurance products offered in the Indian insurance market, IRDAI says there has been a steep increase in premium rates under some of the health insurance products provided to senior citizens aged 60 years and above.
The premium rate is primarily based on the estimated claims outgo and the expenses, including acquisition costs incurred by the insurance company for acquiring and servicing the insurance policies.
The claims outgo mainly depends on the amounts charged by the hospitals for various treatments or surgeries.
Over the past few months, IRDAI says it has undertaken a series of reforms reinforcing the empowerment of policyholders and bolstering inclusive health insurance, while enabling a conducive environment for ease of doing business, promoting innovation and providing wider choice to the customers.
Measures taken in the interest of policyholders include: mandatory time limits for approval of cashless claims, mandating insurers to make available products, add-ons, and riders to provide a wider choice to the policyholders, prospects catering to all ages, all types of medical, pre-existing diseases and chronic conditions, all system of medicines and treatments, all types of hospitals and healthcare providers.
The time period for considering pre-existing disease and moratorium period is also reduced.
IDRAI has mandated a customer information sheet (CIS) to be provided by the insurer along with every policy document which explains the basic features of insurance policies in simple words like type of insurance, sum insured, coverage details, exclusions, sub-limits, deductibles and waiting periods.
Furthermore, for the benefit of senior citizens, the regulatory framework requires all insurers to establish a separate channel to address their health insurance-related claims and grievances. The details of such channels are required to be published on the respective insurer's website, the regulator says.