Irdai bars widening of health covers if premiums increase

MUMBAI: The Insurance Regulatory and Development Authority of India (Irdai) has said that insurers cannot make any significant changes in coverage of health insurance policies that result in an increase in premium. The regulator, however, allowed minor modifications and offer of an optional cover where the premium is shown separately.

Irdai is also taking a closer look at pricing and has asked companies to get an actuarial review of the viability of every health plan at the end of the year to ensure that all health products are sustainable. According to Future Generali chief operating officer Shreeraj Deshpande, in terms of the circular, insurers should not add additional benefits or upgrade them in the existing health products if it would affect the premiums.

“The additional benefits can be offered on an optional basis as add-on covers or optional covers with standalone pricing so that customers can take an informed decision,” said Deshpande. The regulator has said that the changes will enable policyholders to make an informed choice. Also, the appointed actuary must submit a report to the board at the end of every financial year on the viability of existing health insurance products along with the analysis of the experience with recommended corrective action.

“Under the additional norms on modification of health products (including personal accident, or PA, and travel), Irdai has clarified that insurers can choose to add new benefits/upgrade existing benefits as an add-on cover with a standalone premium rate for it. Thus, providing customers an opportunity to enhance the coverage by opting for add-on covers according to their needs,” said Bajaj Allianz General Insurance MD & CEO Tapan Singhel.

“Additionally, the regulator has also shared norms on presentation format of policy contract, which insurers need to follow for all health insurance products with effect from October 1, 2021. This will lead to further simplification and a better understanding of the policy for customers as the same format will be used across all insurers using plain and simple language,” he added.

The new directive from the regulator comes at a time when several insurance companies have hiked health premiums during the pandemic. Many companies have cited regulations that compel them to provide wider cover than earlier on health insurance policies. This has not gone down well with the regulator. Irdai had pointed out at that time that the wider cover prescribed by the regulator would result in a premium increase of only 5%.