Lok Sabha Question No. 3387 (UNSTARRED), answered on 2024-12-16
Subject: Insurance Scheme for Senior Citizens
Ministry: FINANCE
Asked by: Shri Rajiv Pratap Rudy

## GOVERNMENT OF INDIA MINISTRY OF FINANCE DEPARTMENT OF FINANCIAL SERVICES

## LOK SABHA UNSTARRED QUESTION No. 3387

TO BE ANSWERED ON MONDAY,16 DECEMBER, 2024/AGRAHAYANA 25, 1946 (SAKA)

## INSURANCE SCHEME FOR SENIOR CITIZENS

3387. Shri Rajiv Pratap Rudy:

Will the Minister of FINANCE be pleased to state:

- a) The number of insurance schemes which are currently available to senior citizens in the private insurance market and the key features of these schemes;
2. (b) whether the Government has assessed the affordability of private insurance schemes for senior citizens, particularly for those in lower-income groups;
3. (c)  whether  the  Government  has  established  guidelines  for  private  insurers  to  ensure  fair coverage and premium rates for senior citizens and the enforcement mechanisms in place;
4. (d) the measures being taken to address complaints related to denial of claims or unfair terms for senior citizens by private insurance companies?

## ANSWER

## THE MINISTER OF STATE IN THE MINISTRY OF FINANCE (SHRI PANKAJ CHAUDHARY)

(a) to (d): Insurance sector regulator the Insurance Regulatory and Development Authority of India (IRDAI) has issued IRDAI (Insurance Products) Regulations, 2024 and Master Circular on IRDAI (Insurance Products) Regulations 2024-Health Insurance, containing provisions to ensure that insurers make available products / add-ons / riders to provide wider choice to the policyholders / prospects catering to all ages. These two documents direct that insurers shall allow for customization of products by customer by providing the flexibility to choose products / add-ons / riders as per his/her specific needs.

In compliance with the above, insurers are offering various health products that are offering coverage to all age groups including senior citizens. The list of some of these products along with major feature is at Annexure.

Regulatory norms are in place to provide framework for designing and pricing of insurance products with particular focus on appropriateness and fairness. IRDAI (Insurance Products) Regulations, 2024, inter-alia, mandate insurers to ensure that the premium rates are fair and not excessive, inadequate, unfairly discriminatory and provide value for money. Further, the said regulation requires that all the risks relevant to the products are appropriately considered in the pricing.

Both offsite supervision on an ongoing basis and periodical supervision of insurers are carried out by IRDAI to ensure compliance with the extant laws and regulations.

Various channels are available for grievance redressal which include Bima Bharosa portal, which is an integrated grievance management system and a centralized repository for industrywide grievance data. Policyholders can also lodge their complaints by sending an email to complaints@irdai.gov.in.  The  Insurance  Ombudsman,  is  an  alternate  grievance  redressal platform to resolve grievances of aggrieved policyholders against insurers and intermediaries in  a  speedy  and cost-effective manner. They have 17 offices in the country. Insurers must comply with the Ombudsman's decision within 30 days, or face a penalty of ₹5,000 per day of delay.

For  protecting  policyholders'  interests,  IRDAI  has  issued  Regulation  on  Protection  of Policyholders' Interests and Allied Matters, 2024 and Master Circular thereon.

Further, for addressing the grievances of senior citizens, IRDAI has stipulated that all insurers shall  establish  a  separate  channel  to  address  the  health  insurance  related  claims  and grievances of senior citizens. The details of such channel shall be available in the website of the insurers.

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