IRDAI & Health Insurance: What Every HR Team Should Know
Quick answer: IRDAI (Insurance Regulatory and Development Authority of India) regulates health insurance in India. Key regulatory protections include strict claim processing turnaround times, a 5-year moratorium period after which claims cannot be contested for non-disclosure, standardized permanent exclusions, free-look periods, and direct grievance escalation via Bima Bharosa.
Key facts
- Regulatory Authority: IRDAI protects policyholder interests and regulates insurers and brokers.
- Moratorium Period: 60 continuous months (5 years) of cover makes claims non-contestable for non-disclosure.
- Grievance Escalation: Escalate unresolved claims to IRDAI Bima Bharosa or the Insurance Ombudsman.
Key IRDAI Regulations Governing Health Insurance
IRDAI regularly issues Master Circulars to protect policyholders and streamline insurance operations. For HR teams managing corporate GMC policies, understanding IRDAI guidelines ensures employees get fair treatment during claims.
Frequently asked questions
What is the IRDAI 5-year moratorium period rule?
After 60 continuous months of health insurance cover, an insurer cannot reject a claim based on pre-existing non-disclosure or misrepresentation, except in cases of proven fraud.
How do I register an IRDAI complaint against an insurer?
You can register grievances online through IRDAI’s Bima Bharosa portal, call toll-free 155255, or email complaints@irdai.gov.in.
Need group insurance for your team?
ClearCover is an IRDAI-registered insurance broker in Bangalore for group & employee-benefits insurance.