The Insurance Regulatory and Development Authority of India (IRDAI) has imposed a ₹1 crore penalty on Nissan Renault Financial Services India, a corporate agent, for violations of motor insurance service guidelines. According to The Hindu BusinessLine, the regulator has directed the firm to place the order before the Board of the Corporate Agent in the upcoming Board Meeting and provide a copy of the minutes of the discussion to the regulator. "The Corporate Agent should submit an Action Taken Report to the Authority within 90 days from the date of this Order," IRDAI stated on Monday. This penalty action demonstrates the regulator's commitment to enforcing compliance across all insurance service providers.
The Insurance Regulatory and Development Authority of India (IRDAI) has established a facility that allows health insurance claim splitting across multiple insurers. According to reports from Upstox, this facility provides crucial financial relief when a single policy's sum insured value proves insufficient for medical expenses. The mechanism enables policyholders to claim portions of their medical bills from different insurers, creating a combined coverage approach that ensures complete treatment costs are covered.
As reported by Upstox, the claim splitting facility operates through a systematic approach. For instance, if a medical bill totals ₹15 lakh, policyholders can claim ₹10 lakh from an insurer with a ₹10 lakh sum insured value, while the remaining ₹5 lakh balance can be claimed from another insurer. This approach ensures that total claims from all insurers equal the original and eligible hospital bill amount, preventing any fraudulent activities.
According to the detailed process outlined by Upstox, the claim splitting procedure involves five key steps. Step 1 requires immediate notification of all insurers upon hospitalization, including disclosure of other active policies to prevent rejection. Step 2 involves selecting the primary insurer with higher sum insured value and cashless claims capability. Step 3 requires submitting pre-authorisation forms or claim forms with requisite documents to the hospital's insurance desk. Step 4 involves collecting settlement documents including claim settlement statements and attested copies of discharge summaries and hospital bills. Step 5 involves filing the remainder claim with the secondary insurer using the settlement statement and original hospital documents.
Health insurance cumulative bonuses reward policyholders for maintaining claim-free years, with benefits typically ranging from 10% to 100% of the sum insured. According to Business Standard, the bonus is generally accumulated up to a maximum period of 10 years and can increase coverage by ₹50,000 for a ₹5 lakh sum insured after a claim-free year. There are three main types: percentage-based bonuses where the bonus increases each year proportionally to the sum insured, fixed sum bonuses where insurers offer specific amounts regardless of the original coverage, and renewal-based bonuses that are added to the new policy year after each claim-free year. Some insurers also offer higher bonuses for consecutive claim-free years, with policyholders receiving better rewards for remaining claim-free for two or three years compared to just one year.
As reported by Upstox, the IRDAI has implemented several important restrictions and requirements for claim splitting. Mandatory disclosure remains essential when purchasing or making claims, ensuring both insurers are aware of other active policies. The contribution clause elimination in indemnity-based health insurance policies allows policyholders to choose primary insurers without restrictions. Settlement sequence requires processing the initial claim first before filing subsequent claims, while time limits must be adhered to avoid rejection. Most importantly, total claims must equal original eligible expenses only, with any claims exceeding this amount constituting fraudulent activity. When selecting health insurance plans, policyholders should compare premium amounts, look for extensive coverage, and carefully review waiting periods, exclusions, and policy limitations before purchasing.
