The Insurance Regulatory and Development Authority of India (IRDAI) has established comprehensive provisions to safeguard the rights of policyholders. These provisions aim to ensure transparency, accountability, and fairness in insurance practices while empowering policyholders with clear guidelines and protection mechanisms. Below is a detailed overview of the key provisions:

Key Provisions of IRDAI Regulations for Policyholders' Rights

1. Clear and Transparent Communication
   1. Insurance companies must provide policyholders with:
      • Accurate and detailed information about the product.
      • A copy of the policy document within 30 days of policy issuance.
      • A key feature document outlining major inclusions, exclusions, terms, and conditions.
2. Free Look Period:
   • A 15-day free look period (30 days for policies sold through distance marketing) is provided for the policyholder to review the policy terms and cancel if unsatisfied.
   • The policyholder is entitled to a refund of the premium, minus applicable charges such as medical and administrative expenses.
3. Claims Handling Process:
   1. Insurers must have a well-documented claims procedure available to policyholders.
   2. Insurers must:
      • Acknowledge claim intimation within 2 working days.
      • Communicate deficiencies in documents within 7 days.
      • Settle claims within 30 days of receiving all required documents.
      • Pay interest at 2% above the bank rate for delays beyond the stipulated period.
4. Policy Renewal Rights
   • Policyholders have the right to renew their policies (especially in health insurance) without discrimination, provided the premiums are paid on time.
   • Insurers cannot arbitrarily refuse renewal or impose new terms unless explicitly stated in the policy.
5. Transparency in Premium and Charges
   • Insurers must disclose:
     • The premium breakdown
     • Any charges or fees applicable
     • Details of any changes in premium due to age, lifestyle, or other factors
6. Grievance Redressal Mechanism
   • Insurers must have a grievance redressal system in place to handle complaints.
   • Policyholders can escalate complaints to:
     • The insurer's Grievance Redressal Officer (GRO).
     • IRDAI's Integrated Grievance Management System (IGMS).
     • The Insurance Ombudsman if the issue remains unresolved within 30 days.
7. Prohibition of Mis-Selling
   1. Insurers and intermediaries are strictly prohibited from misrepresenting products or benefits.
   2. Agents and brokers must:
      • Clearly explain the features, benefits, exclusions, and risks of the product.
      • Not sell unsuitable policies to vulnerable customers (e.g., senior citizens).
8. Policy Surrender and Portability
   • Policyholders can surrender their policy and receive the applicable surrender value.
   • In health insurance, policyholders can port their policy to another insurer without losing continuity benefits (e.g., waiting period for pre-existing diseases).
9. Non-Discrimination
   • Insurers must not discriminate against policyholders based on gender, race, religion, or geographical location.
   • Premiums and benefits must be uniformly applied unless actuarial justifications exist.
10. Third-Party Involvement
    • Policyholders are protected from harassment by third-party service providers, such as TPAs (Third-Party Administrators) in health insurance.
    • Insurers are responsible for monitoring and resolving complaints against such entities.

The IRDAI regulations are designed to empower policyholders by ensuring fairness, transparency, and accountability in insurance practices. By defining clear rights and responsibilities, these provisions establish a robust framework that protects policyholders while fostering trust and integrity in the insurance sector.