It is important that  a policyholder understand the terms and conditions of the policy that has been purchased. Therefore it is imperative to have a document that explains in simple words, the basic features of  the policy and provides necessary information.

With the above objective in mind, the customer information sheet (CIS) has been revised   &  is to be provided by insurers to all policyholders. This circular has been  issued by IRDAI in terms of Regulation 26 of I ROAi (Health Insurance) Regulations,2016

The customer information sheet  now seeks to convey basic information about the policy purchased in a manner that is easily understood.As per the IRDAI circular dated 30.10.2023, the revised format of CIS (Annexure-A) shall be implemented w.e.f. 01.01.2024.

As per the circular, Insurers, intermediaries and agents shall forward the Customer Information Sheet to all policyholders and acknowledgement, physical or digital, shall be duly obtained.

The circular specifies that     The CIS shall have minimum font size 12" (Arial) or above.The circular states that all details provided in the CIS shall be duly completed. The policy document shall contain a cross reference  to the CIS. 

All details provided for in the CIS shall be duly filled in.

The policy document forwarding letter shall contain a cross reference to the CIS.  

Understanding Your Insurance Policy: A Comprehensive Guide

Insurance is a vital aspect of financial planning, offering protection and peace of mind in times of unforeseen events. To ensure that policyholders are well-informed about their coverage, rights, and responsibilities, insurers provide a detailed document known as the "Customer Information Sheet" or "Know Your Policy.

I: Financial Limits of Coverage:

One of the fundamental aspects of any insurance policy is the financial limits of coverage. These limits are categorized into sub-limits, co-payments, deductibles, and any other relevant thresholds. Sub-limits are pre-defined caps beyond which the insurance company will not provide coverage. Co-payments require the policyholder to contribute a specified amount or percentage towards the claim. Deductibles are the amounts deducted from the total claim, and other limits may also apply. Understanding these limits is crucial, as exceeding them may result in out-of-pocket expenses for the policyholder.

II: Expenses Sharing in Case of Claim:

The policy specifies certain conditions under which the policyholder is required to share the costs. This includes expenses beyond sub-limits, room and ICU charges exceeding defined thresholds, and deductibles per claim or per year. Clarity on these aspects empowers the policyholder to make informed decisions and minimizes surprises during the claims process.

III. Claims/Claims Procedure:

Efficient claims processing is a cornerstone of a reliable insurance policy. The document outlines the Turn Around Time (TAT) for various stages of the claims process, including preauthorization of cashless facilities and final bill authorization. Additionally, policyholders are provided with essential details such as network hospital information, helpline numbers, and a list of blacklisted hospitals. This information streamlines the claims process, ensuring timely and hassle-free settlements.

IV:-Policy Servicing:

Access to effective policy servicing is crucial for a smooth insurance experience. The document includes essential details such as the insurer's call center number and contact information for company officials. This facilitates open communication channels, allowing policyholders to address queries, concerns, or seek assistance promptly.

V: Grievances/Complaints:

Every insurance policy includes a mechanism to address grievances and complaints. The document provides information on the Grievance Redressal Officer, the insurer's grievance portal/department, and the Ombudsman. These channels ensure that policyholders have a means of escalating issues and seeking resolution in a fair and transparent manner.

VI: Things to Remember:

The document concludes with important reminders for policyholders. It emphasizes the option of Free Look Cancellation within a specified period, details the policy renewal process, and explains the possibilities of migration and portability. Changes in the sum insured and the concept of a Moratorium Period are also elucidated, providing clarity on the policy's dynamic nature.

In conclusion, the Customer Information Sheet or Know Your Policy document serves as a comprehensive guide for policyholders. It empowers them with the knowledge needed to navigate the complexities of their insurance coverage, facilitates informed decision-making, and ensures a more transparent and beneficial relationship between the insurer and the insured. As a policyholder, taking the time to thoroughly understand these key points can make a significant difference in maximizing the benefits of an insurance policy.

 The circular issued by IRDAI can be read at Document Detail - IRDAI