Section 11 in Insurance Regulatory and Development Authority of India (Health Insurance) Regulations, 2016
11. Designing of Health Insurance Policies.
- a. Subject to Regulation 3 as applicable, Health insurance product may be designed to offer various covers;i. For specific age or gender groupsii. For different age groupsiii. For treatment in all hospitals throughout the country, provided the hospitals comply with the definition specifiediv. For treatment in specific hospitals only, provided the morbidity rates used are representativev. For treatment in specific geographies only, provided the morbidity rates used are representativeProvided, such specifications are disclosed clearly upfront in the product prospectus, documents and during sale process. And provided that no insurer shall offer any benefit or service without any insurance element.b. In order to facilitate offering of innovative covers by insurers, 'Pilot products' may be designed and filed for approval of the Authority in accordance with the Product Filing Guidelines specified by the Authority. Pilot products referred herein can be offered only by General Insurers and Health Insurers for policy tenure of one year. Every Pilot product may be offered upto a period not exceeding 5 years. After 5 years of launch of the pilot product, the product needs to get converted into a regular product or based on valid reasons may be withdrawn subject to the insured being given an option to migrate to another product subject to portability conditions. The Authority may specify guidelines for Pilot Products from time to time. Where a pilot product gets converted into a regular product, any exception made in these Regulations for pilot products shall no longer apply and the insurer shall ensure compliance with all the provisions of these Regulations.c. Insurer shall not compel the insured to migrate to other health insurance products. In case of migration from a withdrawn product , the insurer shall offer the policyholder an alternative available product subject to portability conditions.d. Insurers shall ensure adequate dissemination of product information on all their health insurance products on their websites. This information shall include a description of the product, copies of the prospectus as approved under the Product Filing Guidelines, proposal form, policy document wordings and premium rates inclusive and exclusive of Service Tax as applicable.[e. To enable access to the basic health insurance covers, all insurers shall offer a standard health insurance product as per the guidelines as may be specified by the Authority from time to time. [Inserted by Notification No. F.No. IRDAI/Reg/14/165/2019, dated 19.11.2019 (w.e.f 12.7.2016).]f. Any of the exclusions in all health insurance policies shall be subject to the guidelines as may be specified by the Authority from time to time.]
