Finance

CIS Explained: Comprehensive Guide to the New Health Insurance Rule in 2024

Imagine your loved one suffered a sudden cardiac arrest, and you rushed them to the hospital. In the mix of chaos, the hospital staff asked you about your medical insurance plan.

Rushing home, you dig out the policy but find it loaded with confusing jargon. The increased stress levels during such emergency situations make it even more difficult for you to understand the coverage.

To help out in such a situation, IRDA has asked insurance companies to issue a revised CIS (Customer Information Sheet) that will summarise the key details of your health insurance plans, including your critical illness insurance plans. But what is CIS? Let us understand it through this blog.

What is CIS?

As per the regulation of IRDA, it is mandatory that every health insurance policyholder must be provided with customer information in a standardised format according to the guidelines.

A customer information sheet is a guideline document that gives clear and concise information, i.e., key details of the health plan. Earlier, this document had a complex structure with jargon and technical language, making it difficult for policyholders to grasp the essential information.

Therefore, on  1 January 2024, the Insurance Regulatory and Development Authority of India made an announcement stating the revision needed in the CIS  document. Therefore, the revised customer information sheet will outline all the essential information in simple, understandable language, easing the burden on the policyholder during times of crisis.

Essential of CIS for New Health Insurance Rules

Following are the rules CIS in health Insurance must follow.

Title Description
Name of Insurance Product/Policy The name or title of the insurance plan or policy, such as Tata AIG Health Insurance Plan
Types of Insurance Product/Policy This includes the nature of the insurance

  1. Indemnity-Covers losses up to the specific limit, i.e., the sum insured under the policy.
  2. Benefit- Pays a fixed amount on the happening of a covered event.
  3. Both Indemnity and Benefit-Combination of both types.
Sum Insured (Basis)for Health Insurance Online Shows how the sum insured is calculated

●       Individual Sum Insured- Each member having a separate sum insured under the policy.

●       Floater Sum Insured-All the members having a single sum insured limit under the policy.

Policy Coverage for online medical policy This includes all kinds of coverage the policy will provide. For Instance-

●       Hospital admission

●       Pre-hospitalisation

●       Post-hospitalisation

●       Daycare procedures

●        Critical illnesses  Diagnosis

●       Daily cash benefit

●       OPD/Dental/Maternity coverage

●        Emergency/Travel Medical Assistance

●       Personal Accident Cover

●        Travel Cover

Note: The insurance provider must ensure that all benefits are listed

Exclusions Then, CIS must also include what the policy does not cover, ensuring complete transparency for policyholders.
Waiting period Then, CIS must also include the waiting period for all riders and policies. This may include waiting periods for various conditions and treatments, including pre-existing diseases.
Financial limits of coverage All the financial limits must be included

●        Sub-limit– The sub-limit refers to a predefined limit beyond which the insurer will not pay.

●        Co-payment-The co-payment refers to a specified amount/percentage of the admissible claim amount to be paid by the policyholder/insured.

●        Deductibles– Deductibles refer to the amount deducted from the claim amount or the limit up to which the insurer will not pay any claim.

●        Other limits– Any additional financial constraints which are essential for the policyholders.

Claims/Claims Procedure ●       The CIS must include guidance on the process for cashless service and claim reimbursement.

●       Further, it should all mention the turnaround time for claims settlement, network hospital details, helpline number, how to download and steps to get the claim form.

Policy Servicing It should also have the contact information of the insurance company, i.e., the call centre number and details of company officials for policy-related inquiries.
Grievances/Complaints Further, it should also provide information about grievance redressal mechanisms, which include information about the Grievance Redressal Officer, insurance company grievance portal/department, and Ombudsman(final body to address any complaint).
Things you need to know: The CIS should provide information about all essential aspects, such as

●        Free Look cancellation period, policy renewal procedure, and

●       Options for migration and portability, with specific processes provided by the insurer.

Your Obligations It should also include policyholder obligations, which include all critical disclosure about pre-existing conditions and other important information during the policy period.

Conclusion

The new health insurance rules focusing on revised CIS is specially designed to simplify the process at the time of raising a claim and the receipt of the same.  In a nutshell, it provides complete information, thereby making processes clear to understand by the policyholder.

IRDA initiated the Revised CIS to empower policyholders to make informed decisions when purchasing insurance. The new format has been implemented from January 1, 2024.

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