IRDAI Mandates Key Points in Customer Information Sheet for General Insurers

Hyderabad: In a significant move to enhance customer awareness and understanding of insurance policies, the Insurance Regulatory and Development Authority of India (IRDAI) has mandated that general insurers must provide a Customer Information Sheet (CIS) to policyholders with immediate effect. This directive is part of the IRDAI's Master Circular on IRDAI (Insurance Products) Regulations 2024, issued last Friday.

Purpose of the CIS:

• To provide essential policy information in a concise and understandable format.

• To ensure policyholders have a clear grasp of the coverage, exclusions, and claims process.

Key Points Mandated in the CIS:

1. Product Name and Unique Identification Number (UIN):

• The CIS must include the product name and UIN assigned by the IRDAI.

2. Structure:

• Clearly state the basis of Sum / Limit Insured, such as Indemnity, Modified Indemnity, Fixed Benefit, or Parametric Limit.

3. Interests Insured:

• List the broad categories of interests insured under the policy.

4. Sum Insured / Motor Insured Declared Value:

• Provide details on the main Sums/ Limits insured per coverage section.

5. Policy Coverage:

• List and describe each insured coverage in detail.

6. Add-on Cover:

• Describe each Add-on Cover opted by the policyholder, including Sum/Limit Insured.

7. Loss Participation:

• Explain how Deductibles are applied, listing separate Deductibles per coverage.

8. Exclusions:

• List all applicable exclusions clearly.

9. Special Conditions and Warranties:

• State and explain any special conditions and warranties, including policyholder obligations.

10. Admissibility of Claim:

• Outline the broad principles of claim admissibility or denial.

• Provide a sample claim calculation process for retail products.

11. Policy Servicing:

• Include details on claim intimation and processing, toll-free/IVRS number, website/email, designated company officials for claims, and procedures for cashless service and claim reimbursement.

• Specify the Turn Around Time (TAT) for claims settlement and escalation matrix if TAT is not met.

12. Grievance Redressal and Policyholders Protection:

• Provide details on policyholder protection, Grievance Redressal Officer, Bima Bharosa Portal, and Insurance Ombudsman contact details, toll-free number, and email.

13. Obligations of the Policyholder:

• Emphasize the need to disclose all information accurately when filling the proposal form.

• Notify the insurer of any changes or additions to declared information immediately.

• Warn that non-disclosure of material information can affect claim settlement.

• Highlight the need to disclose other material information during the policy period.

14. Local Language Availability:

• CIS will be made available in local languages upon request.

Accessibility and Transparency:

• General insurers must provide a web link to product-related documents, including the CIS, on their websites.

• In case of any conflict, the terms and conditions in the policy document will prevail.

The IRDAI's directive aims to improve transparency and policyholder awareness, ensuring customers are well-informed about their insurance coverage. This move is expected to foster trust and enhance the overall customer experience in the insurance sector.