1) All insurance policies must be issued in electronic format.
All insurance policies must be issued in electronic format. Electronic insurance policies can be digitally signed by the client. Clients can request the insurance company if they want the policies to be issued in physical format. Please note that if you want policy documents or brochures in physical format, you must mention this in the proposal form.
2) Thinking about buying life insurance? Key documents you should obtain
The insurer must issue the life insurance policy within 15 days of accepting the proposal form. With an insurance policy, the insured must obtain the following documents from the insurance company:
i) Cover letter of the policy document informing the free review period
ii) Policy document
iii) A copy of the proposal form submitted by the prospect
iv) Copy of benefits illustration
v) Customer Information Sheet
vi) Copy of the needs analysis document within the framework of the suitability assessment, if applicable,
vii) Any other document that is required by the specific product.
3) Mandatory CIS for all insured: Key details to verify in a CIS for a life insurance policy
The Customer Information Sheet (CIS) is a vital document that insurers mandatorily provide to their customers along with their insurance policies. It serves as a summary of the key features and benefits of the policy, ensuring that policyholders are well informed about their coverage. As per regulations, the CIS must be provided in the format specified in “Schedule D” of the Insurance Act for life insurance policies. This ensures consistency and clarity for policyholders.
Key information included in a CIS:
Type of insurance: Whether it is term life insurance, whole life insurance or another type of coverage.
Sum insured: The amount that will be paid to the beneficiary in the event of a claim.
Benefits: A detailed explanation of the coverage provided by the policy.
Exclusions: A list of events or situations that are not covered by the policy.
Important details: Information about the free review period, policy renewal date, options such as policy revitalization and loans, and other relevant details.
Complaints procedure: Instructions on how to file a claim.
Policy Service: Information on support and customer assistance.
Grievance resolution: Details on how to make a complaint and contact information for the Insurance Ombudsman.
4) 30-day free review period for life insurance policies
For life insurance policies of one year or more, the insured will have a free review period of 30 days. In case the insured is satisfied with the terms or conditions of the policy, he or she has the option to return the policy within those 30 days to the insurer for cancellation.
5) How long does it take to resolve a claim on a life insurance policy? Irdai sets deadlines, check here
As a policyholder, you need to know how quickly your insurance company settles claims. According to Irdai, death claims, except in cases where an investigation is required, must be settled within 15 days of the claim being initiated.
For death claims requiring investigation, settlement must be made within 45 days of notification of the claim.
Requests for partial delivery or withdrawal must be resolved within seven days of the start of the claim.
Maturity benefits, survivor benefits, annuity payments, and income benefits must be provided on the maturity date.
“In case the claim is not settled within the prescribed time frame, the claimant will be entitled to interest at the bank rate plus 2% from the date of receipt of the notice till the date of payment. Such interest will be paid by the insurer ex officio along with the claim amount,” the IRDAI said.
6) The nomination must
When completing the nomination form, the candidate must provide the candidate’s details. Please note that nomination is mandatory to facilitate payment of the claimed amount in the event of the candidate’s death.
life insured. The policyholder may designate one or more persons and specify the percentage of loss.
amount to be paid to each nominee.
7) Health Insurance Guidelines for Insurers
Insurers should make available additional products/add-ons/clauses to provide a wider choice to the insured/potential clients they serve.
a) All ages
b) All types of existing medical conditions;
c) Pre-existing diseases and chronic conditions;
d) All systems of medicine and treatments, including allopathy, AYUSH and other systems of medicine;
e) Any treatment situation including home hospitalization, outpatient care
treatment (OPD), day treatment and home treatment;
f) All regions, all occupational categories, persons with disabilities and any other categories;
g) All types of hospitals and health care providers must be adapted to the financial capacity of the insured or potential insured. Insured persons will not be denied coverage in case of emergency situations.
Products must be made available in accordance with various laws: Insurers must offer
products in accordance with the relevant provisions of the following Laws:
a) The Mental Health Care Act 2017;
b) The Rights of Persons with Disabilities Act, 2016;
c) The Surrogacy Regulation Act, 2021;
(d) The Transgender Persons Rights Protection Act of 2019, and
(e) The HIV and AIDS Prevention and Control Act of 2017.
8) CIS for health insurance policies: What details should you verify?
The Customer Information Sheet is also mandatory for health insurance policyholders. It must include the following details:
i) Type of insurance
ii) Sum insured
iii) coverage provided,
iv) Summary of exclusions that the policy does not cover,
v) Sublimits (a predefined limit above which the insurer will not pay),
vi) Deductibles (specified amount up to which an insurer will not pay any claim/which will be deducted from the total claim if the claim amount is greater than the specified amount), copayment,
vii) waiting period(s) (period during which certain diseases or treatments are not covered),
viii) certain important issues such as the free examination period, policy renewal, migration, portability and moratorium period.
The CIS will also contain information on the complaints procedure, policy servicing and complaints resolution mechanism, including contact details of the Insurance Ombudsman for the relevant jurisdiction.
9) Health insurance claim settlement rules: Non-cash claims must be settled within 3 hours.
In a move aimed at improving policyholder experience, insurers have been directed to expedite the cashless claim settlement process.
Under the new guidelines, insurers must resolve cashless authorization requests within one hour of receiving them. In addition, final authorization for discharge must be granted within three hours of receiving the hospital’s request.
Irdai states that “under no circumstances will the insured be forced to wait to be discharged from hospital.” If there is a delay of more than three hours, the insurer will be responsible for any additional costs incurred by the hospital.
In the event of the death of the insured during treatment, insurers are obliged to:
1) Immediately process the claim settlement request.
2) Ensure the prompt release of the deceased’s remains from the hospital.
These measures are expected to provide greater comfort and peace of mind to policyholders and their families during difficult times.
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