'ËĘ ÁflÁŸĸĘ∑§ •ı⁄U Áfl∑§Ę‚ Ž˝ĘÁœ∑§⁄UáĘ - IRDA

Arranging together all aspects of a topicAll aspects of each topic can be put together. For exampleTopicContentsInsurance Cover 1. What the policy pays.2. Conditions for payment.3. All benefits and riders4. Deductibles, Co-pay, Co-insurance5. What the policy pays after a waiting period6. What the policy never coversRenewal 1. How the insured can renew the policy.2. Renewal is not a right. It must be accepted by the insurer.3. How claims will affect renewal terms.4. Benefits if the insured has no claims.5. Renewal before the end of the policy has benefits – viz.cumulative bonus, cover of pre-existing diseases, etcClaims Procedure 1. Notice of claim2. Claim itself: form, documents, procedures3. Time limits for notices and claims, and effect of not submittingin time.4. Statement that claim is subject to verification.5. The insured must cooperate and give information.6. Cashless facility7. How claims affect benefits and renewals8. Benefits if no claims are made.3. Ambulance services - 1% of the suminsured or `2000/- whichever is lessshall be reimbursable in case patienthas to be shifted from residence tohospital in case of admission inEmergency Ward / I.C.U. or from oneHospital / Nursing home to anotherHospital / Nursing Home by registeredambulance only for better medicalfacilities.Simplifying insurance and legal termsThe insured will not be aware of insuranceprinciples and practices. He will not befamiliar with insurance jargon. Words like‘deductibles’, ‘co-payment’, ‘contribution’,‘loading’ and ‘excess’, ‘coverage’, ‘adverseclaim experience’, ‘subrogation’, may beknown to an insured in their ordinarysense, but not in the insurance context.The policy can give the special meaning ofthese words in the part that givesdefinitions, else can explain them withexamples.Some aspects will be repeated acrossgroups. Thus the effect on benefits of aclaim or of no-claim will be reflected in thetopic of renewal, and of claims. However,the insured wanting to renew a policymust know both these aspects, as also theinsured who wishes to make a claim. Andthe first might read only the topic ofrenewal and not about claim, and thelatter may read only about claims and notabout renewals.Repetition can be reduced by stating theaspect in detail in one topic, andmentioning it in the other topic with areference to the first topic.Presenting informationInformation can be arranged in tables orcharts. These convey information clearly. Atable or chart also trims text. A personreading a table or chart can graspinformation faster and accuratelyInformation arranged in tables or charts isclear. For example:Before:Reimbursable expenses –1. Room, Boarding and NursingExpenses as provided by the Hospital/Nursing Home not exceeding 1% ofthe Sum Insured or `5000 /- per daywhichever is less.2. I.C. Unit expenses not exceeding 2% ofthe Sum Insured or `10,000 /- per daywhichever is less.(Room including I.C.U. stay should notexceed total number of admissiondays)After: (Table)Item of ExpenseSimilarly, the insured may not know themeaning and effect of legal terms like‘basis of contract’, ‘waiver’, conditionprecedent’, ‘disclaimer’, ‘repudiation’,‘entire agreement’. The policy can statethese in plain language or can explainthem.With such explanations and examples, theinsured will understand how the policyaffects him.Example 1.Before:The fulfilment of the terms and conditionsof this policy (including the payment ofMaximum we payRoom, Boarding and Nursing Expenses 1% of Sum Insured or `5000 per day,whichever is lessIntensive Care Unit expenses2% of Sum Insured or `10000 per day,whichever is less. (Stay in the ICU will becounted as days admitted as in-patient)Ambulance services for shifting the 1% of sum insured or `2000,insured from residence into thewhichever is lessemergency ward or ICU in a hospital,or from one hospital to another hospitalfor better medical facilitiesirda journal October 201233