health insurance cis: Health insurance claim-settlement time, coverage, key details to be available in single, easy-to-understand document from January 1, 2024

health insurance cis: Health insurance claim-settlement time, coverage, key details to be available in single, easy-to-understand document from January 1, 2024

The Insurance Regulatory and Development Authority of India (IRDAI) has asked insurers to provide updated customer information sheets (CIS) for health insurance policies highlighting all key policy details in simple terms from January 1, 2024. From type of policy to coverage details to waiting period to limit and sub-limits to exclusions to free-look period to portability to guidance on procedure for claims submission and contact details for filing complaints will be available “in simple language in a snapshot” in the customer information sheet, the insurance regulator said in a press release on October 30, 2023.

What is a customer information sheet (CIS)?

A customer information sheet or CIS gives you a glance at the key policy details in a summarised 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. IRDAI said, “This step is expected to result in better-informed policyholders, reduced disputes and delays, and a seamless health insurance experience for policyholders.”

Here’s how the updated customer information sheet of a health insurance policy will look, as per IRDAI

The CIS is designed to provide policyholders all important information about their health insurance
policy in simple language in a snapshot which includes the following, among others:

a) Name and type of policy
b) Coverage details
c) Waiting periods
d) Limits and sub-limits
e) All exclusions
f) Concepts like
i. free look cancellation
ii. migration
iii. portability
iv. moratorium period
g) Guidance on the procedure for claims submission
h) Contact details/web links for grievance/complaint filing

“Additionally, it will also highlight the obligations of policyholders to make transparent and fair disclosures of relevant material information about their health, as non-disclosure of the same may affect the claim settlement,” the insurance regulator said.

IRDAI has also asked insurers to ensure following compliances while issuing the CIS:

a) Insurers, intermediaries, and agents should distribute the updated CIS to all policyholders, ensuring physically or digitally documented confirmation.
b) If a policyholder wants, the CIS should be made available in his or her local language.
c) The font size on the CIS must be a minimum of 12 (Arial) or bigger.
d) All details provided for in the CIS should be duly filled in.
e) The forwarding letter for the policy document should contain a reference to the CIS.

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 added.

How will this updated CIS benefit the health insurance policyholders?
Typically, the health insurance policy document is rather lengthy, and policyholders must carefully examine crucial information. With this overhauled customer information sheet, the policyholders will be able to obtain facts like exclusions, waiting periods, financial limits of coverage, and claim procedures in very simple words, said Rakesh Goyal, Director of Probus Insurance Broker.

The new CIS further breaks down the complex terms of a health insurance policy including sub-limit, all exclusions, and migrations, and mentions them in straightforward language, barring jargon or technical terms, said experts.

“(IRDAI amending) the CIS, or customer information sheet, is definitely a customer-friendly move. It will provide policyholders with a quick, convenient guide about their policy and will also provide a hassle-free experience at the time of hospitalisation, as they will not have to deal with voluminous policy documents,” said Amit Chhabra, Chief Business Officer – Health and Travel Insurance,

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Author: Shirley