Laws and sections by number or title, due dates, pages, and updates.
All general and health insurers must apply new design norms for health insurance products and modify existing products to comply with regulatory standards. Every health insurance product must cover all pre existing diseases after a waiting period of forty-eight months or a lower period. Insurers must give credit for accrued waiting period benefits when withdrawing products or migrating policies. New products filed on or after the specified date must follow these guidelines. Existing non-compliant products must either be withdrawn, filed on a certification basis without premium changes, or filed with a base premium rate change within plus or minus five percent before the final compliance deadline.
What you must do
Key dates
Who is affected
Thresholds
If you do not comply
Ask about this circular
[Image omitted. See the official document.]
Ref: IRDAI/HLT/REG/CIR/175/09/2019
27th September, 2019
To All General and Health Insurers,
Modification Guidelines on Product Filing in Health Insurance Business:
(xv) Every Health Insurance product shall cover all Pre Existing Diseases disclosed by the persons to be insured immediately after the expiry of the forty-eight months waiting period or such lower period as stipulated in the product.
(xvi) Where Insurers allow lower waiting period for the Pre Existing Diseases (PEDs) (say 12 months or 24 months or 36 months), in the event of withdrawal of the said product, the existing Insurer shall give credit to the accrued waiting period benefits of PEDs gained under the withdrawn product and allow coverage on any of the health products available in his product portfolio with no additional waiting period beyond the chosen PED period of the withdrawn product. However, in case of migration to another insurer, the new insurer may impose only the unexpired / residual waiting period not exceeding 48 months from the date of first issuance of porting out policy.
MODIFICATION OF EXISTING HEALTH INSURANCE PRODUCTS:
The Health Insurance Products that do not fall within the above referred clauses shall be filed as 'Modification' as specified in the Guidelines on Product Filing in Health Insurance Business Ref: IRDA/HLT/REG/CIR/150/07/2016 dated 29th July, 2016.
This has the approval of the competent authority.
(D V S Ramesh) General Manager (Health)
Page 1 of 5
Annexure - I
CERTIFICATE
Name of the Insurance Company: Name of the Product: UIN of the Product:
This is to certify that we have not changed the benefit structure, terms and conditions (other than those related to exclusions to make the product compliant with the Guidelines on Standardization of Exclusions in Health Insurance Contracts, Modification Guidelines on Standardization in Health Insurance and Modification Guidelines on Product Filing in Health Insurance Business) and the premium rates as approved by Insurance Regulatory and Development Authority of India (IRDAI) vide letter dated --- of the above product. The product that would be offered shall be in compliance to the extant regulatory framework specified by the Authority.
Date: Place:
CMD or CEO
Appointed Actuary
Chief Compliance Officer
Page 3 of 5
Annexure - 2
CERTIFICATE
Name of the Insurance Company:
Name of the Product:
UIN of the Product:
Actual and estimated ICR and Combined Loss Ratio of the Product in the preceding / succeeding three financial years.
| Year | Actual Net Incurred Claims Ratio | Actual Combined Loss Ratio |
|---|---|---|
| N | ||
| N-1 | ||
| N-2 |
| Year | Estimated Net Incurred Claims Ratio | Estimated Combined Loss Ratio |
|---|---|---|
| N | ||
| N+1 | ||
| N+2 |
Premium change effected: + / - --------% (mention the percentage of change effected in the premium)
This is to certify that we have not changed the benefit structure, terms and conditions (other than those related to exclusions to make the product compliant with the Guidelines on Standardization of Exclusions in Health Insurance Contracts, Modification Guidelines on Standardization in Health Insurance and Modification Guidelines on Product Filing in Health Insurance Business)) that were approved by IRDAI vide letter dated --- of the above product. The proposed change of premium is within +/- _ % (mention the change effected) of the premium rates for any given age and term of the originally approved individual product. The product that would be offered shall be in compliance to the extant regulatory framework specified by the Authority.
Date:
Place:
CMD or CEO
Chief Compliance Officer
Page 4 of 5
Certificate by Appointed Actuary (the language shall not be altered)
"I ---- (name of Appointed Actuary), the appointed actuary, hereby solemnly declare that the information furnished above is true.
I also certify that the proposed premium change is in conformity with the provisions of the Circular ----------dated-------.
Place:
Date:
Signature of Appointed Actuary
Page 5 of 5
