Insurance firms directed to list basic policy information in simple language on a single page
According to insurance regulator IRDAI, simple language will enable the consumer to understand and follow the policy documents thoroughly.
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The Insurance Regulatory and Development Authority of India (IRDAI), the country’s insurance regulator, directed insurance companies on Monday to ensure that all the main information about a policy is listed in a simple form on one page for the ease of the consumer, with effect from January 1, 2024.
According to the regulator, simple language will enable the consumer to understand and follow the policy documents thoroughly.
In a communication to insurance companies, the IRDAI said: “It is important for a policyholder to understand the terms and conditions of the policy that has been purchased. Since a policy document may be fraught with legalese, it is imperative to have a document that explains in simple words the basic features with regard to the policy and provides necessary information.”
The IRDAI directed insurance companies to mandatorily list all the relevant policy details in a revised customer information sheet (CIS).
"It is observed that several complaints are still emanating as a result of the asymmetry of information between the insurer and the policyholder. In this backdrop, the existing customer information sheet has been improved and now seeks to convey basic information about the policy purchased in a manner that is easily understood," the IRDAI added.
The regulator directed all the insurers, intermediaries and agents to forward the customer information sheet to all policyholders and obtain the acknowledgment in a physical or digital form. It also directed insurance companies to make sure that the customer information sheet is also made available in a local language if desired by the policyholder.
Currently, insurance companies provide all the relevant information on their policies in legal language and in a scattered form.
Here's the revised format of the customer information sheet, as shared by the insurance regulator:
| S No. | Title | Description | Policy clause No. |
| (Please refer to the applicable policy clause number in the next column) | |||
| 1 | Name of the insurance product/policy | XXXXXX | |
| 2 | Policy number | ||
| 3 | Type of the insurance product/policy | Indemnity (where insured losses are covered up to the sum insured under the policy | |
| Benefit (where an insurance policy pays a fixed amount under the policy on the occurrence of a covered event | |||
| Both indemnity and benefit (where policy has elements of both the above) | |||
| 4 | Sum insured (basis) along with the amount | Individual sum insured (where each member has a separate sum insured under the policy | |
| OR | |||
| Floater sum insured (where all members under the policy have a single sum insured limit which may be utilised by any or all members) | |||
| 5 | Policy coverage (what does the policy cover?) | Expenses in respect of: | |
| (Policy clause No./Nos.) | Admission in hospital beyond xx hours | ||
| Pre-hospitalisation (treatment prior to admission in the hospital) within xx days from the date of discharge amounting to x% of claim | |||
| Specified/listed procedure in case of xx critical illnesses | |||
| Diagnosis of an illness of specified severity | |||
| Daily cash benefit of Rs ___per day during the admission in the hospital | |||
| OPD/dental/maternity coverage | |||
| Emergency or travel medical assistance | |||
| Personal accident cover | |||
| Travel cover | |||
| (Note: This is an indicative list. The insurer must ensure that all the benefits of the policy are listed above) | |||
| 6 | Exclusions (what does the policy not cover?) | (Note: The insurer has to ensure that all the applicable exclusions are listed here) | |
| 7 | Waiting period | Initial waiting period: XX days for all illnesses (not applicable in case of continuous renewal or accidents) | |
| The time period during which the specified diseases/treatments are not covered | Specific waiting periods (non-applicable for claims arising due to an accident): | ||
| It is counted from the beginning of the policy coverage | xx months for xx diseases/procedures | ||
| yy months for yy diseases/procedures | |||
| Pre-existing diseases: Covered after xx months | |||
| 8 | Financial limits of coverage | The policy will pay only up to the limits specified hereunder for the following diseases/procedures: | |
| i. Sub-limit (it is a pre-defined limit and the insurance company will not pay any amount in excess of this limit) | XX XX | ||
| ii. Co-payment (it is a specified amount/percentageof the admissable claim amount to be paid by the policyholder/insured) | In case of a claim, this policy requires you to share the following costs: expenses exceeding the following sub-limits | ||
| iii. Deductible (it is a specified amount: | Room/ICU charges beyond --------- | ||
| up to which an insurance company will not pay any claim, and | For the following specified diseases: | ||
| which will be deducted from the total claim amount (if the claim amount is more than the specified amount) | --------- | ||
| iv. Any other limit (as applicable) | --------- | ||
| XXXX | |||
| Deductible of Rs XXX per claim/per year/both | |||
| 9 | Claims/claims procedure | Details of the procedure to be followed for the cashless service as well as for the reimbursement of claim including pre- and post-hospitalisation | |
| Turnaround time (TAT) for claims settlement: | |||
| i. TAT for pre-authorisation of cashless facility XXXX | |||
| ii. TAT for cashless final bill authorisation: XXXX | |||
| Provide the details/web link for the following | |||
| i. Network hospital details | |||
| ii. Helpline number | |||
| iii. Hospitals that are blacklisted or from where no claims will be accepted by the insurer | |||
| iv. Downloading/getting the claim form | |||
| 10 | Policy servicing | The call centre No. of the insurer | |
| Details of company officials | |||
| 11 | Grievances/complaints | Details of | |
| The grievance redressal officer of the insurer | |||
| The insurance company grievance portal/department | |||
| Ombudsman | |||
| (Please provide the contact details, the toll free No. and the email) | |||
| 12 | Things to remember | Free look cancellation: You may cancel the insurance policy if you do not want it within xx days from the beginning of the policy | |
| The insurer to specify the process for free look cancellation | |||
| Policy renewal: Except on grounds of fraud, moral hazard, misinterpretation or non-cooperation, the renewal of the policy shall not be denied, provided the policy is not withdrawn | |||
| Migration and portability: When your policy is due for renewable, you may migrate to another policy with us or port your policy to another insurer | |||
| Insurer to specify the process for migration and portability | |||
| Change in the sum insured: The sum insured can be changed (increased/decreased) only at the time of renewable or at any time subject to underwriting by the company. For an increase in SI, the waiting period if any shall start afresh only for the enhanced portion of the sum insured. | |||
| Moratorium period: After the completion of eight continuous years under the policy, no look back to be applied. This period of eight years is called as the moratorium period. The moratorium would be applicable for the sums insured for the first policy and subsequently, the completion of eight continuous years would be applicable from the date of enhancement of the sums insured only on the enhanced limits. | |||
| After the expiry of the moratorium period, no health insurance policy shall be contestable except for proven fraud and permanent exclusions specified in the policy contract. | |||
| 13 | Your obligations | Please disclose all pre-existing disease(s) or condition(s) before buying a policy. Non-disclosure may affect claim settlement. | |
| Disclosure of other material information during the policy period | |||
| The insurer to specify the material information | |||
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