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Providing mandatory medical insurance-IRDA

ADMIN / Latest Updates December 21, 2021 / LATEST UPDATES

Circular

Ref: IRDAI/HLT/CIR/MISC/093/04/2020

Date: 16-04-2020

Providing mandatory medical insurance coverage to workers as part of the National Directives of MHA, GOI

Ref: IRDAI/HLT/CIR/MISC/093/04/2020.

16th April, 2020

All General and Stand along Health Insurers (Except AIC and ECGC),

Sub: Providing mandatory medical insurance coverage to workers as part of the National Directives of MHA, GOI

Reference is invited to Order No. 40-3/2020-DM-I (A) dated 15th April, 2020 issued as part of the Consolidated Revised Guidelines by Ministry of Home Affairs, GOI. As per the said order, inter alia; the following are stipulated:
- All industrial and commercial establishments, work places, offices etc. shall put in place arrangements for implementation of Standard Operating Procedure (SOP) before starting their functioning.
- As per clause no. 5 of Annexure – II of the said SOP for social distancing for offices, workplace, factories and establishments, medical insurance for the workers to be made mandatory.
In light of the above, all General and Health Insurance companies may offer comprehensive health insurance policies either to individuals or groups in order to enable the listed organisations / employers / establishments comply with the above referred directions.
The insurers are advised to devise comprehensive Health insurance products with simple wordings, conditions and at affordable cost to be offered to the stated organisations.
The above referred organisations should be able to continue the Medical Insurance Policy offered by insurers not only for the present situation but for all time.

T L Alamelu MEMBER
(Non Life)

Providing Mandatory Medical Insurance IRDA

About IBAI

Insurance Brokers Association of India (IBAI) was incorporated as a Company under Section 25 of the Companies Act, 1956 vide Certificate of Incorporation No. U 67120 MH 2001 NPL 132860 dated 25th July 2001. IBAI has a Memorandum of Association as well as an Articles of Association, as required under the Companies Act, 1956. IBAI is run by a Board of Directors who are elected by the members.

Corporate Office

INSURANCE BROKERS ASSOCIATION OF INDIA ( IBAI)

Mahalaxmi Industrial Estate , Unit No 319, David S Barretto Rd, Gandhi Nagar, Lower Parel, Mumbai, Maharashtra 400013

Disclamer : Disputes do arises under the insurance policies either due to repudiation of claims or payment of claim amount not as per the claim bill filed. To resolve these issues, many options are available to the policyholders as under: Complaint may be filed with the Insurer – Integrated Grievance management System (IGMS) – File a Complaint with Ombudsman – File a legal case under Consumer protection Act 1986 1 . Complaint may be filed with the Insurer: Approach the Grievance Redressal Officer of its branch or any other office that you deal with. -Give your complaint in writing along with the necessary support documents – Take a written acknowledgement of your complaint with the date. The insurance company should deal with your complaint within 15 days. – If that does not happen or if you are unhappy with their solution you can: Approach the Grievance Redressal Cell of the Consumer Affairs Department of IRDA: Call Toll Free Number 155255 (or) 1800 4254 732 or Send an e-mail to [email protected] 2. Integrated Grievance management System (IGMS) – Make use of the Integrated Grievance Management System – Register and monitor your complaint at https://igms.irda.gov.in/ or compliant form may also be to IRDAI at Hyderabad – TAT for resolving the complaints is 3 days to 6 months in life insurance and 3 days to 30 days in General Insurance. 3. File a Complaint with Ombudsman Any individual (not any business entity) and claim amount not exceeding Rs 30 lakhs including interest may file a complaint in the prescribed form an Insurance Ombudsman in the respective State of the Policyholder. The decision of the Insurance Ombudsman is binding on the Insurer while the Policyholder has the option to file a complaint under Consumer Protection Act 1986. There is no fee to file a complaint application. The time limit of decision is 30 days from the date of filing the complaint. The legal Advisor is not permitted to present at the time of hearing. 4. File a legal case under Consumer protection Act 1986: Any Individual or Business Entity can file a complaint with the following consumer courts: District Forum if the premium amount ,in particular policy, is not more than Rs 100 lakhs – State Commission if the premium amount, in particular policy, is more than 100 lakhs but nor more than 1000 lakhs – National Commission, if the premium amount , in particular policy, is more than Rs 1000 lakhs. – Though there is no Stamp duty to file a complaint but nominal amount of Court fees is to be deposited while filing a complaint. The appeal can be filed with the State Commission for the decision of the District forum and National Commission for the decision of the State Commission. The appeal against the decision of the National Commission lies with the Hon’ble Supreme Court.