IRDAI circular dated 31st May, 2021 asking general insurance companies and health insurance companies to expeditiously process insurance claims relating to cyclones Tauktae & Yaas. Read on.
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Insurance Regulatory Development Authority (IRDA) has made few changes to the Indian Insurance Companies (Foreign Investment) Rules, 2015. Some of the salient features are enumerated below.
Rule 4 has been amended: Rule 4 hitherto said “
An Indian Insurance Company shall ensure that its ownership and control shall remain at all
times in the hands of resident Indian entities
Now the amended version reads as follows:
“4. (1) In an Indian Insurance Company having foreign investment,—
(a) a majority of its directors,
(b) a majority of its Key Management Persons, and
(c) at least one among the chairperson of its Board, its managing director and its Chief Executive Officer, shall be Resident Indian Citizens.
Explanation.—For the purposes of this rule and rule 9, the expression “Key Management Person” shall have the same meaning as assigned to it in guidelines made by the Authority on corporate governance for insurers in India.
(2) Every Indian Insurance Company having foreign investment, existing on or before the date of commencement of the Indian Insurance Companies (Foreign Investment) Amendment Rules, 2021, shall within one year from such commencement, comply with the requirements of the provisions of sub-rule (1).
4A. In an Indian Insurance Company having foreign investment exceeding forty-nine per cent.,—
(a) for a financial year for which dividend is paid on equity shares and for which at any time the solvency margin is less than 1.2 times the control level of solvency, not less than fifty per cent. of the net profit for the financial year shall be retained in general reserve; and
(b) not less than fifty per cent. of its directors shall be independent directors, unless the chairperson of its Board is an independent director, in which case at least one-third of its Board shall comprise of independent directors
Rule 5 which presently allowed FDI proposals in the insurance sector under automatic route upto 49% has been amended to provide for automatic approvals upto 74%.
IRDAI circular dated 23rd april, 2021 advising health insurance companies to honour cashless covid claims.
1. There are reports of certain network providers (hospitals) charging high rates and insisting on cash payments from the policyholders for providing treatment to COVID-19 infected patients despite having cashless arrangement with Insurers.
2. In compliance with the provisions of Regulation 31of IRDAI ( Health Insurance ) Regulations, 2016, the Insurers, in case of “cashless claim” under a health insurance policy, are advised to ensure expeditious settlement of such claims on cashless basis in accordance to the Service Level Agreements ( SLAs) entered with hospitals.
3. While reviewing cashless requests the Insurers are also advised to ensure that the policyholders are charged as per the rates agreed to by network providers wherever applicable. Insurers are also advised to ensure that hospitals do not levy any additional charges for the same treatment other than those rates that are agreed with the insurers.
4. In order to ensure that all network providers extend cashless services to policyholders and to address any issues causing inconvenience to policyholders while availing cashless service, the Insurers are advised to put in place an effective communication channel with all the network providers for prompt resolution of grievances of policyholders. Insurers are advised to report levying of excess charges or denial of cashless facility to the respective State Governments for appropriate action.
5. All Insurers are directed to ensure that the “reimbursement claims “under a health insurance policy shall be settled as per the terms and conditions of the respective policy contract expeditiously. Insurers are advised to issue suitable guidelines on this to all TPAs.
IRDAI has issued an advisory to all the insurance companies to follow the TRAI guidelines regarding unsolicited commercial communications to the general public. It has said that all insurance companies should register themselves with their respective telecom service providers and also register the template of the message to be sent out. Gist of circular follows:
IRDAI circular dated 23rd March, 2021 on the subject, which is self explanatory.
his has reference to the provisions of Regulation 4 of IRDAI (Issuance of e-Insurance policies) Regulations,2016 and the exemption granted vide circular Ref: IRDAI/Life/Cir/Misc/207/08/2020 dated 4th August 2020. In the wake of continuing situation of Covid19 Global Pandemic with all public health measures in place such as hand hygiene and social distancing, and taking into account (i) and (ii) below,
i) the feedback received from the Life Insurers expressing difficulties in printing, handling and dispatch of policy documents
ii) the desirability of adopting total digital means of doing business in the interests of policyholders and other stakeholders
exemption is allowed for six months more by Competent Authority under Proviso to Regulation 4(iii) of the Referred Regulations, from the requirement to issue policy document, copy of proposal form in physical form. The exemption is subject to
a) Life Insurer confirming the date of receipt of electronic policy document by the policyholder through PIVC or other means and preserving the proof so that Free Look period may be calculated from that date.
b) Thirty (30) days Free Look period may be allowed for all such electronic policy documents.
c) Return of electronic policy document by mail by policyholder with clear intention of cancellation of policy shall be valid for Free Look Cancellation.
d) Express consent of the policyholder to receive electronic policy bond is required. If a policyholder insists on hard copy, the same has to be issued without any charges.
e) Policy document shall be sent to the email id submitted by the proposer.
The exemption shall be valid for all policies issued up to 30th September 2021.
IRDAI circular dated 1st March, 2021 laying down the basic information that should be provided on health insurance to policy holders at the time of issue of the policy and thereafter twice a year. Read on.
1. Attention is drawn to the provisions of Regulation 12 of IRDAI (Protection of Policyholders’ interests) Regulations, 2017 specifying therein minimum information to be provided as part of health insurance policy. While the policy document is forwarded with relevant information, in order to continue the relationship with policyholders and to ensure information flow, it is considered important to periodically notify the policyholders certain relevant and key details relating to health insurance coverage available to the policyholders.
2. In order to ensure flow of relevant information to policyholders the following norms are specified:
i) All the general and health insurers as part of policy servicing, shall communicate the following basic information about the health insurance policy to the policyholders:
a. Name of Product and policy number,
b. Extent of coverage available by way of available Sum Insured and Cumulative Bonus,
c. Number of insured people covered under policy,
d. Policy period,
e. Number and amount of claim settled (under relevant period), if any,
f. Balance Sum Insured and Accrued cumulative bonus available, if any,
g. Due date of renewal and premium payment frequency,
h. Premium amount due on renewal (to be specified at the time of renewal)
i. Grace Period (within 5 days after renewal due date)
j. Contact details (for any query or other issues) of customer support service of Insurer, Toll Free No. or e-mail Id etc.
ii) The above information shall be communicated by insurers to all the policyholders twice in a year, i.e, 6 months after issuance of policy and at least 1 month prior to the renewal due date. However, in case of a multiyear policy, the information can be shared with a frequency of 6 months from the date of issuance of policy.
iii) In addition to the above, in the event settlement of any claim under a health insurance policy, the insurer shall also communicate the details of balance sum insured along with the cumulative bonus available, if any, to the policyholder. This shall be notified to the policyholders within 15 days of settlement of claim.
iv) The insurer may choose any mode of communication (message, e-mail, letter etc) for the purpose of notifying the above referred information. The sample messages / communications that all the insurers to notify to the policyholders is placed at Annexure-1 for illustration purpose only. Insurers can improve on the same while refraining from making the message complex, unintelligible or too long with unnecessary information. These norms are applicable to all individual (both indemnity and benefit based) health insurance policies.
3. All the insurance companies shall comply with the instructions issued in this circular at the earliest and not later than 1st June 2021.
IRDAI circular dated 9th February, 2021 on the subject, which is self explanatory
All Insurers excluding GIC Re, FRBs and Lloyd’s (India)
Re: Issuance of digital insurance policies by insurance companies via Digilocker
Digilocker is an initiative under the Digital India program by the Government of India where citizens can get authentic documents/ certificate in digital format from original issuers of these certificates. It aims at eliminating or minimising the use of physical documents and will enhance effectiveness of service delivery, making these hassle free and friendly for the citizens.
2. In the insurance sector, Digilocker will drivereduction in costs, elimination of customer complaints relating to non-delivery of policy copy, improved turnaround time of insurance services, faster claims processing and settlement, reduction in disputes, reduction in fraud and improvement in customer contactability. On the whole it is expected that it will lead to better customer experience.
3. In order to promote the adoption of Digilocker in the insurance sector, the Authority advises all insurers to enable their IT systems to interact with Digilocker facility to enable policyholders to use digilocker for preserving all their policy documents.
4. The insurers should inform their retail policyholders about Digilocker and how to use it. Insurers are also advised to enable the process by which the policyholders can place their policies in the digilocker.
5. Digilocker team in NeGD (National e-Governance Division) under Ministry of Electronics and Information Technology shall provide necessary technical guidance and logistic support to facilitate adoption of Digilocker. A brief for on-boarding documents and contact details of resource persons in NeGD is annexed.
IRDAI circular dated 2nd December, 2020 laying down guidelines for grant of fresh/ renewal license to act as licensed surveyors and loss assessors.
Sub: Guidelines for grant of fresh licence / renewal of license to act as Insurance Surveyor and Loss Assessor
1. These guidelines set out the procedure for obtaining fresh license or renewal of licence to act as a surveyor and loss assessor.
2. The guidelines are being issued under Sec.14 of the IRDAI Act,1999 and in terms of Regulations 28 of Insurance Regulatory and Development Authority of India (Insurance Surveyors and Loss Assessors) Regulations, 2015.
II . Licensing Procedure:
1. Registration: the applicants are required to register with the IRDAI portal viz. www.irda.bap.org.in and obtain a user ID. Applicants are requested to ensure that correct E-Mail ID and mobile number are provided.
2. Submission of application: The applicants shall submit the prescribed forms available in the IRDAI Portal duly filled in all aspects along with all necessary documents through the portal. While uploading the documents, applicants shall ensure that the same are legible. Illegible documents shall be rejected.
The applicant shall upload the documents online but shall maintain the original physical copies of all the relevant certificates with him throughout the period of validity of licence issued by Authority and shall produce the same whenever sought by Authority.
All documents shall be self-attested.
3. Licence fee: The payment of applicable fee shall be made using the online payment providers available in the portal.
i) BillDesk and PayGov are the two different online payment service providers who provide the following payment options to the appliants:
i. Net Banking
i. Net Banking
ii. Credit Card
iii. Debit Card
ii) The fee paid is non-refundable.
III. Fit and Proper Criteria:
“Fit and Proper” criteria refers to the criteria for determining the suitability of an Applicant, whether individual or corporate including Directors or Partners, and their employees (in case of Corporates) for grant of fresh license / renewal of license are persons of integrity, having appropriate skills and experience. For the purpose of determining whether an applicant / surveyor is a ‘Fit and Proper Person’, the following shall be considered-
a) Financial integrity;
b) Absence of convictions or civil liabilities involving moral turpitude;
c) Appropriate competence, experience and qualification;
d) Good reputation and character;
e) Efficiency and honesty;
f) Absence of any disqualification to act as ‘intermediary or insurance intermediary’ as stipulated in Section 42D of the Insurance Act, 1938
The applicants shall furnish a declaration cum undertaking in the prescribed form IRDAI AF 20 to determine the ‘fit and proper’ status.
IV. Issuance of Licence
On completion of the procedure stated in II and III above, the licence will be issued and mailed to the registered E-Mail ID.
V. Issuance of Licence
The existing forms available on the IRDAI Portal www.irda.bap.org.in, as are relevant, shall continue to be utilized till such time the revised forms are implemented on the Portal. Applicant shall submit FORM IRDAI 20 AF (Fit and Proper Criteria) along with other relevant application as below:
a) FORM IRDAI 1 AF (Fresh Individual)
b) FORM IRDAI 3 AF (Fresh Corporate)
c) FORM IRDAI 5 AF (Renewal Individual)
d) FORM IRDAI 6 AF (Renewal Corporate)
e) FORM IRDAI 13 (Enrollment)
f) FORM IRDAI 17 AF (Modification Individual)
g) FORM IRDAI 18 AF (Modification Corporate)
These guidelines shall come into force with immediate effect.
IRDAI circular dated 15th October, 2020 mandating all public sector units general insurance companies to appoint nodal officers in all their ombudsman centres. Nodal officer at each centre will be responsible for co-ordinating and liaisoning with the chief ombudsman of the insurance company.
- The lnstitution of lnsurance Ombudsman plays a vital role in providing
resolution in timely and cost effective manner. lnsurers need to have a greater liaison with every lnsurance Ombudsman office in order to ensure that the complaints are disposed of in a timely manner.
- lnsurance Ombudsmen have expressed that they are facing difficulties in
dealing with cases of PSU General lnsurance Companies in the absence of any responsible Officer who can liaison with their Offices to ensure that the self contained note is filed in time and documents/information sought by lnsurance Ombudsman is submitted without any delay.
- To ensure proper and timely disposal of complaints, the following procedure shall be adopted by all the PSU general insurance companies:
a) Appoint a “Nodal Officer”, not below the rank of Deputy Manager for
each of the 17 Ombudsman Centres.
b) The names /Phone No’s including mobile No’s / e-mail id’s of the Nodal
Officers shall be shared with the Ombudsman/ECOl.
c) The Nodal Officer shall be responsible for placing self contained notes
before lnsurance Ombudsman within the specified timeline. He/she
shall also ensure that all the information/documents called for by
lnsurance Ombudsman are submitted in a timely manner.
d) The Nodal officer shall ensure that the concerned officer of the
lnsurance Company attend the hearing on the date and time specified
by Ombudsman in the notice for hearing.
e) The Nodal Officer shall ensure compliance with the recommendation or Award of the Ombudsman as the case may be within the specified
timeline, and update the details of compliance in Complaints
Management System of ECOI.
- The Public Sector General lnsurance Companies shall designate Nodal Officers for all the offices of lnsurance Ombudsman Office latest by 2010.2020 and forward the list of the same with contact details (e-mail id, Phone no.) by uploading the same in their website. As and when there is a change in the said list, the same shall be notified to ECOI immediately so as to enable them to keep the list updated at all times. The ECOI shall share the updated list with IRDAI from time to time.
The above procedure shall come into force with immediate effect.
IRDAI has vide its circular dated 13th October, 2020 allowed insurers to offer renewal, migration & portability as may be applicable to the covid standard health policies subject to certain conditions to be fulfilled. Gist of the circular is given below.
1. Reference is drawn to clause 12 of Section C of Guidelines on Covid Standard Health Policy (Corona Kavach) (Ref: IRDAI/ HLT/ REG/ CIR/ 163/ 06/2020 dated 26th June, 2020) and clause 10 of Section C of Guidelines on Covid Standard benefit based Health Policy (Corona Rakshak) (Ref: IRDAI/ HLT/REG/CIR/164/06/2020 dated 26th June, 2020) vide which it was specified that lifelong renewability, migration and portability are not applicable to these products.
2. Reference is also drawn to circular (Ref No: IRDAI/ HLT/ REG/ CIR/ 192/07/2020 dated 21.07.2020) on filing of Corona Kavach Policy as group health insurance product vide which insurers were allowed to offer Corona kavach policy as group product.
3. In partial modification of the above guidelines, insurers have the choice to allow renewal, migration and portability, as may be applicable, for these COVID specific standard health products (i.e, “Corona Rakshak Policy”, “Corona Kavach Policy” and “Group Corona Kavach policy”) subject to the following norms.
a) ‘Corona Kavach’ and ‘Corona Rakshak’ policies of any tenure may be renewed for further terms of three and half months (3 ½ months), six and half months (6 ½ months) or nine and half months (9 ½ months) as per the option exercised by the policyholder. The renewal shall be subject to the underwriting policy of the insurer.
b) Renewals, if any, may be done before the expiry of the existing policy contract.
c) Where policy is renewed, additional waiting period of 15 days shall not be imposed and the coverage shall be continued seamlessly.
d) During renewal, sum insured may be allowed to be changed by the policyholder. For any increase in the sum insured, the waiting period shall start afresh only for the enhanced portion of the sum insured.
e) Corona Kavach and Corona Rakshak policies are permitted to be renewed till 31st March,2021 complying with clause 5 of Guidelines on introduction of short term health insurance policies providing coverage for COVID-19 disease (Circular Ref No: IRDAI/HLT/REG/ CIR/156/06/ 2020 dated 23.06.2020).
a) In respect of Corona Kavach individual policies, insurers have the choice to offer migration to any other indemnity based health insurance product offered by them as per the option exercised by the policyholder.
b) In respect of Corona Kavach Group policies, insurers have the choice to provide migration to the members insured to any other individual indemnity based health policy at the point of exit of the member insured from the group policy or the cessation of coverage of the underlying group policy.
c) Where migration is allowed, the accrued gains of waiting period served in the existing Corona Kavach policy (Individual/Group) shall be protected in respect of coverage for Covid-19, in the migrated policy.
6. Portability: General and Health Insurers are permitted to allow portability of Corona Kavach (individual) policy from one insurer to another. The accrued gains of waiting period served in the existing Corona Kavach policy shall be protected in respect of coverage of Covid-19, by the porting-in insurer.
7. Where migration/portability from the Corona Kavach policy (Group/Individual, as applicable) is allowed by the insurers, such migration/portability to any other comprehensive health insurance policy shall be allowed, till the end of policy period of the existing Corona Kavach policy.
8. This has approval of the Competent Authority.
IRDAI circular dated 7th October, 2020 on the subject,
Re: Additional Norms on portability under Health Insurance policies
- Reference is drawn to Chapter VIII of “Consolidated Guidelines on Product filing in Health Insurance Business” (Ref: IRDAI/ HLT/ REG/ CIR/ 194/07/2020 dated 22.07.2020) through which guidelines on migration and portability of health insurance policies were specified.
- Further to the above referred guidelines, for seamless coverage with continuity of benefits to the account holders of various banks who are provided health insurance coverage through group insurance schemes, the following guidelines are hereby issued.
a. Members of an indemnity based group health insurance policy offered to account holders of a bank are allowed portability of their coverage to another indemnity based group health insurance policy offered by a different insurer to the account holders of the same bank.
b. The portability will be offered subject to the option exercised by an individual member of the group policy.
c. All other norms specified in Chapter VIII of the above referred guidelines are also applicable.
- These additional guidelines are issued in exercise of the powers vested under Regulation 17 of IRDAI (Health Insurance) Regulations, 2016 read with Section 34(1) of the Insurance Act, 1938 and will come into force with immediate effect.
- This has the approval of the competent authority.
Public notice posted on IRDAI site. Public should take care and buy policies only from recognised & approved insurance companies.