IRDAI asks general insurers to provide `Customer Information Sheet’ to all of their retail policyholders

by AIP Online Bureau | Jun 10, 2024 | Indian News, Non-Life, Regulation, Reinsurance | 0 comments

The IRDA has outlined 14 key points which have to be mentioned mandatorily in the `Customer Information Sheet’ by the general insurers with immediate effect

Hyderabad: In a bid to empower the customers to have a better grasp over their policies issued by the domestic general insurers, insurance regulator IRDAI has asked the companies to prepare a Customer Information Sheet(CIS) with immediate effect for their policyholders providing key information about the policies issued .

The IRDAI has issued Master Circular on IRDAI (Insurance Products) Regulations 2024 – General Insurance on Friday last, the regulator has outlined 14 key points, which have to be mentioned in the CIS by the general insurers and they have to take confirmation of the policyholders regarding receiving of such CIS by getting CIS of one or two pages signed by the policyholders.

On request, CIS will be made available in local language

Indian general Insurers have to provide web-link where the product related documents including the CIS are available on their websites and in case of any conflict, the terms and conditions mentioned in the policy document will prevail, said the regulator.

According to the IRDAI, the CIS, which was earlier meant for health policies, will given with every policy in a given format .

This document explains in simple words, basic features of a policy at one place.
It contains in brief the scope of coverage, add-ons, basis of sum insured, sum insured, exclusions, deductibles, special conditions & warranties, endorsements, etc.
It will also contain information regarding the Claims Procedure, Claims intimation and processing, principle for admissibility of claim, sample claim calculation process for retail products, Policy Servicing and Grievance Redressal Mechanism including contact details of Insurance Ombudsman of appropriate jurisdiction.

The CIS will have following key points and also the general insurers need to mention the policy clauses in these documents.

-Product name and Unique Identification Number (UIN) allotted by the IRDAI

–Structure—• State basis of Sum / Limit Insured, Indemnity / Modified Indemnity, Fixed Benefit, Parametric Limit

–Interests Insured– List broad categories,

–Sum Insured / Motor Insured Declared Value Scope
List the main Sums/ Limits insured per Coverage/ Coverage Section,

–Policy Coverage
List and describe each insured coverage,

–Add-on Cover
List and describe with Sum/Limit Insured, each Add-on Cover opted by the Policyholder,

–Loss Participation
State and explain how Deductible is applied. (List separate Deductibles per Coverage),

–Exclusions-List all the applicable exclusions,

–Special Conditions and Warranties (if any)
State and specify context Explain obligations of the Policyholder

–Admissibility of Claim
• Mention the broad principle of admissibility / denial of claims
[Example: Reporting of loss occurrence; Duty of care & loss minimization; Exclusion of Willful Negligence]
• Include a sample claim calculation process for retail products

–Policy Servicing
Claim Intimation and Processing
– Toll free / IVRS number of the Insurer
Website / Email
-Details of designated company officials to be contacted in time of claim
-Details of procedure to be followed for cashless service (In case of Motor Insurance) as well as for reimbursement of claim
-Turn Around Time (TAT) for claims settlement
– Escalation Matrix when TAT is not satisfied

–Grievance Redressal and Policyholders Protection

-State the brief details of Protection of Policyholder’s Interest
– Details of Grievance Redressal Officer of the Insurer
– Bima Bharosa Portal
– Ombudsman,
(Provide contact details, Toll free number and email)

Obligations of the Policyholder
-To disclose all information correctly sought by the insurer at time of filling the proposal form
-In case of any change / modification / addition to the already declared information the same shall be brought to the notice of the Insurer immediately
-Non-disclosure of material information may affect the claim settlement.
-Disclosure of other material information during the policy period.)