New Delhi: The Insurance Regulatory and Development Authority of India (IRDAI) has mandated that, starting from January 1, 2024, insurers must furnish updated Customer Information Sheets (CIS) for health insurance policies.
These sheets will highlight all significant policy particulars in plain and simple terms. These details include policy type, coverage specifics, waiting periods, limits, sub-limits, exclusions, the free-look period, portability options, guidance on claims submission procedures, and contact information for lodging complaints.
This directive was conveyed in a press release by the insurance regulator on October 30, 2023.
Customer Information Sheet (CIS)
A Customer Information Sheet, or CIS, offers an overview of key policy details. Typically, insurers provide this document along with the policy during purchase and at the time of policy renewal.
The redesigned format of the Customer Information Sheet aims to enhance policyholders’ comprehension of the intricate terms and procedures associated with their health insurance policies.
“This step is expected to result in better-informed policyholders, reduced disputes and delays, and a seamless health insurance experience for policyholders,” the IRDAI said.
The CIS is designed to provide crucial information to policy holders regarding their health insurance policy in easy-to-understand language in a snapshot.
It includes the following:
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
IRDAI said, “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.”
Insurers have been asked by IRDAI to ensure the following compliances when CIS is issued:
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.
IRDAI has also mandated that insurers procure signatures of policyholders that indicate that they have noted the intricacies of CIS and received it.
Benefits for health insurance policyholders with the updated CIS
Usually, the health insurance policy document tends to be quite lengthy, requiring policyholders to carefully review essential information.
Rakesh Goyal, Director of Probus Insurance Broker, mentioned that this revamped customer information sheet simplifies crucial details for policyholders, such as exclusions, waiting periods, coverage financial limits, and claim procedures.
Experts have noted that the new CIS dissects the complex terminology found in health insurance policies, including sub-limits, all exclusions, and migrations, explaining them in plain language without the use of jargon or technical terms.
Dhirendra Mahyavanshi, CEO & Co-founder of Turtlemint, an insurtech platform, emphasised the importance of policyholders having a comprehensive understanding of their insurance coverage terms and conditions.
He also highlighted that the revised customer information sheet (CIS) provides easy access to vital information, including the sum assured, policy coverage, exclusions, claims procedures, and more.
This development not only enhances transparency but also empowers policyholders to make informed decisions regarding their insurance needs.
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