{"id":3619,"date":"2021-03-25T06:53:02","date_gmt":"2021-03-25T06:53:02","guid":{"rendered":"https:\/\/swaritadvisors.com\/blog\/?p=3619"},"modified":"2021-03-25T06:54:10","modified_gmt":"2021-03-25T06:54:10","slug":"irdai-modified-the-guidelines-on-product-filing-in-health-insurance-business","status":"publish","type":"post","link":"https:\/\/swaritadvisors.com\/blog\/irdai-modified-the-guidelines-on-product-filing-in-health-insurance-business\/","title":{"rendered":"IRDAI Modified the Guidelines on Product Filing in Health Insurance Business"},"content":{"rendered":"\n<p class=\"has-drop-cap\">On 16.03.2021, the Insurance Regulatory\nand Development Authority of India (IRDAI), by way of Circular Ref No IRDAI\/HLT\/REG\/CIR\/049\/03\/2021,\nhas notified modification in the Guidelines on Product Filing in Health\nInsurance Business. The said circular was notified to all the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chief_executive_officer\">CEOs<\/a> (Chief\nExecutive Officers) of all the General and Standalone Health Insurance\nCompanies.<\/p>\n\n\n\n<p>Further, it shall be noted that the\ncircular issued was in reference to Chapter III of the Consolidated Guidelines\non Product filing in Health Insurance Business, Ref No IRDAI\/HLT\/REG\/CIR\/194\/07\/2020\ndated 22.7.2020. These guidelines were issued to specify the File and Use,\ntogether with the File Procedure in regard to various categories of the\nindividual Products, Add-ons and Riders of the Health Insurance Business.<\/p>\n\n\n\n<p>Moreover, these guidelines are issued\nunder the ambit of powers vested with section 34(1) of the Insurance Act1938\nand under the powers conferred in Regulation 2 (i) (o) of the IRDAI (Health\nInsurance) Regulations 2016.<\/p>\n\n\n\n<p>In this learning blog, the key point of\nconsideration will be the notion of IRDAI, together with the Modified\nGuidelines on Product Filing in Health Insurance Business.<\/p>\n\n\n\n<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_65 counter-hierarchy ez-toc-counter ez-toc-light-blue ez-toc-container-direction\">\n<p class=\"ez-toc-title\">Table of Contents<\/p>\n<label for=\"ez-toc-cssicon-toggle-item-6a3a8fc0b0752\" class=\"ez-toc-cssicon-toggle-label\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/label><input type=\"checkbox\"  id=\"ez-toc-cssicon-toggle-item-6a3a8fc0b0752\"  aria-label=\"Toggle\" \/><nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/swaritadvisors.com\/blog\/irdai-modified-the-guidelines-on-product-filing-in-health-insurance-business\/#Concept_of_IRDAI\" title=\"Concept of IRDAI\">Concept of IRDAI<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/swaritadvisors.com\/blog\/irdai-modified-the-guidelines-on-product-filing-in-health-insurance-business\/#Additional_Guidelines_on_Product_Filing_in_Health_Insurance_Business\" title=\"Additional Guidelines on Product Filing in Health\nInsurance Business\">Additional Guidelines on Product Filing in Health\nInsurance Business<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/swaritadvisors.com\/blog\/irdai-modified-the-guidelines-on-product-filing-in-health-insurance-business\/#Norms_concerning_the_Presentation_of_Policy_Contract\" title=\"Norms concerning the Presentation of Policy Contract\">Norms concerning the Presentation of Policy Contract<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/swaritadvisors.com\/blog\/irdai-modified-the-guidelines-on-product-filing-in-health-insurance-business\/#Conclusion\" title=\"Conclusion\">Conclusion<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/swaritadvisors.com\/blog\/irdai-modified-the-guidelines-on-product-filing-in-health-insurance-business\/#Copy_of_Official_IRDAI_Circular\" title=\"Copy of Official IRDAI Circular\">Copy of Official IRDAI Circular<\/a><\/li><\/ul><\/nav><\/div>\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Concept_of_IRDAI\"><\/span>Concept of IRDAI<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p>The Insurance sector of India is a huge\nmarketplace with various major players operating. So, it becomes significant to\nhave an authority that oversees and monitor the sector. And this is where the IRDAI\n(Insurance Regulatory and Development Authority of India) comes intothe picture.<\/p>\n\n\n\n<p>Further, the IRDA Act acts as the\ngoverning law for IRDAI, and section 14 of the said act contains the scope and\nambit of powers of the Insurance Regulatory &amp; Development Authority of\nIndia to regulate and administer the insurance and reinsurance industry of\nIndia. <\/p>\n\n\n\n<p>Also, it shall be noted that this\nauthority not only has the power to grant the license to <strong><a href=\"https:\/\/swaritadvisors.com\/insurance-broker-license\" class=\"text-primary\">Insurance\nBroker<\/a><\/strong>, Insurance Company, <strong><a href=\"https:\/\/swaritadvisors.com\/insurance-web-aggregator-license\" class=\"text-primary\">Insurance\nWeb Aggregator<\/a><\/strong>, Third Party Administrator License etc., but is\nresponsible for the dispersion of knowledge, awareness, and consciousness about\nthe benefits of insurance products to the general public as well. <\/p>\n\n\n\n<p>Moreover, IRDAI is responsible for\nmaking the general public aware of the advantages and enlightening them\nregarding the other facets as to why insurance is a huge boost to the sector.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Additional_Guidelines_on_Product_Filing_in_Health_Insurance_Business\"><\/span>Additional Guidelines on Product Filing in Health\nInsurance Business<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p>In addition to the guidelines prescribed\nat Clause (C) of Chapter III of the guidelines that the general &amp; health\ninsurers must adhere to, the following norms while effecting such modification\nof existing products has been issued, which are as follows:<\/p>\n\n\n\n<ul><li>The\nGeneral and Health Insurers are not permitted to modify the prevailing benefit,\nor add new benefits in the prevailing products, which results in levying an\nincrease in premium. However, it shall be noted that theinsurers are permitted\nto carry out minor modifications as prescribed at Clause (G) of Chapter III of the\nconsolidated guidelines on product filing in the health insurance business, Ref\nNo IRDAI\/HLT\/REG\/CIR\/194\/07\/2020, dated 22.7.2020. Also, additional new\nbenefits or up-gradation of the existing benefits may be offered by the\ninsurers as an add-on or optional covers, but with a standalone premium rate to\nconfirm an informed choice to the policy holders;<\/li><li>Appointed\nActuary must review the financial viability and feasibility of every health\ninsurance product at the end of every fiscal year that, too, in accordance with\nthe provisions stipulated under Regulation 6 of the IRDAI (Health Insurance)\nRegulations 2016. Also, the report of such review needs to be furnished to\ntheir Board by way of PMC, together with the analysis of both favourable and\nunfavourable experience of each product as well as the suggested corrective\naction, to confirmthe sustainability of the product and to safeguard the\ninterests of the policyholders of the said underlying product;<\/li><li>Further,\nit shall be noted that a status report needs to be submitted by the 30th\nSeptember of every fiscal year to the authority, together with the Board\u2019s\nsuggestions, proposals, and the corrective actions to be undertaken in the\nformat prescribed in Annexure A of this circular. Also, the status report for the\nFinancial Year 2020 to 2021 should be submitted by 30.09.2021;<\/li><\/ul>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Norms_concerning_the_Presentation_of_Policy_Contract\"><\/span>Norms concerning the Presentation of Policy Contract<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p>In addition to the provisions stipulated\nin Clause 4 (viii) of Chapter II of the Guidelines, wherein it is, among other\nthings, specified that the wordings of policy must be simple andin plain\nlanguage.<\/p>\n\n\n\n<p>The same was done to allow all the policyholders\nto easily understand and comprehend the contents of the policy contract.Also, all\ngeneral and health insurers need to arrange the policy contracts of all the health\ninsurance products in the listed order with a clear heading so as to draw the consciousness\nof policyholders.<\/p>\n\n\n\n<p>Moreover, the said format must be\nadopted in respect of all the policies issued from 01.10.2021 onwards:<\/p>\n\n\n\n<ul><li>Policy\nSchedule;<\/li><li>Preamble;<\/li><li>Definition\n(to be bifurcated into the following sections with clear demarcation and sub\ntitles as under)<\/li><\/ul>\n\n\n\n<ol><li>Standard\nDefinitions (means definitions whose wordings are prescribed by IRDAI);<\/li><li>Specific\nDefinitions (means definitions other than those specified under c(i) above);<\/li><\/ol>\n\n\n\n<ul><li>Benefits\ncovered under the policy;<\/li><li>Exclusions\n(to be bifurcated into the following sections with a clear demarcation and sub\ntitles as under)<\/li><\/ul>\n\n\n\n<ol><li>Standard\nExclusions (means definitions whose wordings are prescribed by IRDAI);<\/li><li>Specific\nExclusions (means definitions other than those specified under e (i) above);<\/li><\/ol>\n\n\n\n<ul><li>General\nTerms &amp; Clauses (to be bifurcated into the following sections with a clear\ndemarcation and sub titles as under)<\/li><\/ul>\n\n\n\n<ol><li>Standard\nGeneral Terms and Clauses (means definitions whose wordings are prescribed by <a href=\"https:\/\/www.irdai.gov.in\/\">IRDAI<\/a>);<\/li><li>Specific\nGeneral Terms and Clauses (means definitions other than those specified under f\n(i) above);<\/li><\/ol>\n\n\n\n<ul><li>Other\nTerms and Conditions (Explanation: Customizing the policy contracts with the already\nexisting product in order to abide by the above specified format is not termed\nas a modification.);<\/li><li>The\nwordings and terms of all the standard exclusions, standard definitions, and standard\nterms and clauses used in the policy contract must adhere to the wordings as\nstipulated by the Authority;<\/li><\/ul>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Conclusion\"><\/span>Conclusion<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p>In\na nutshell, the Insurance Regulatory and Development Authority of India, on\n16.03.2021, by way of Circular Ref No IRDAI\/ HLT\/ REG\/ CIR\/ 049\/ 03\/ 2021, has\nissued modification in the Guidelines on Product Filing in Health Insurance\nBusiness. The said circular was passed in reference to Chapter III of the\nConsolidated Guidelines on Product filing in Health Insurance Business, Ref No\nIRDAI\/ HLT\/ REG\/ CIR\/ 194\/ 07\/ 2020 dated 22.7.2020.<\/p>\n\n\n\n<p><strong>Also, Read: <\/strong><mark style=\"background: #fffd03 !important;\"><a href=\"https:\/\/swaritadvisors.com\/blog\/difference-between-insurance-brokers-and-agents\/\">Difference between Insurance Brokers and Agents \u2013 An Overview<\/a><\/mark><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Copy_of_Official_IRDAI_Circular\"><\/span>Copy of Official IRDAI Circular<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n<a href=\"https:\/\/swaritadvisors.com\/blog\/wp-content\/uploads\/2021\/03\/Copy-of-Official-IRDAI-Circular.pdf\" class=\"pdfemb-viewer\" style=\"\" data-width=\"max\" data-height=\"max\"  data-toolbar=\"bottom\" data-toolbar-fixed=\"off\">Copy-of-Official-IRDAI-Circular<br\/><\/a>\n<p class=\"wp-block-pdfemb-pdf-embedder-viewer\"><\/p>\n","protected":false},"excerpt":{"rendered":"<p>On 16.03.2021, the Insurance Regulatory and Development Authority of India (IRDAI), by way of Circular Ref No IRDAI\/HLT\/REG\/CIR\/049\/03\/2021, has notified modification in the Guidelines on Product Filing in Health Insurance Business. The said circular was notified to all the CEOs (Chief Executive Officers) of all the General and Standalone Health Insurance Companies. Further, it shall [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":3621,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[43,50],"tags":[536],"acf":[],"_links":{"self":[{"href":"https:\/\/swaritadvisors.com\/blog\/wp-json\/wp\/v2\/posts\/3619"}],"collection":[{"href":"https:\/\/swaritadvisors.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/swaritadvisors.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/swaritadvisors.com\/blog\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/swaritadvisors.com\/blog\/wp-json\/wp\/v2\/comments?post=3619"}],"version-history":[{"count":4,"href":"https:\/\/swaritadvisors.com\/blog\/wp-json\/wp\/v2\/posts\/3619\/revisions"}],"predecessor-version":[{"id":3625,"href":"https:\/\/swaritadvisors.com\/blog\/wp-json\/wp\/v2\/posts\/3619\/revisions\/3625"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/swaritadvisors.com\/blog\/wp-json\/wp\/v2\/media\/3621"}],"wp:attachment":[{"href":"https:\/\/swaritadvisors.com\/blog\/wp-json\/wp\/v2\/media?parent=3619"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/swaritadvisors.com\/blog\/wp-json\/wp\/v2\/categories?post=3619"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/swaritadvisors.com\/blog\/wp-json\/wp\/v2\/tags?post=3619"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}