Information regarding applicability of Mediclaim 2013 to policy holders who opted to stay with Mediclaim 1996 was sought - PIO provided some information - CIC recommended to put New Health Policy 2013 approved by IRDA on their website
1. The appellant, Shri Shanaram Walavalkar, submitted RTI application dated 05.09.2013 before the Central Public Information Officer (CPIO), Insurance Regulatory & Development Authority (IRDA), Hyderabad seeking information on the following eight points –
(1) whether senior citizens who opted out to stay with Mediclaim 1996 (after introduction of Mediclaim 2007) will continue to stay with Mediclaim 1996 for their renewals,
(2) If no then please provide copy of IRDA approval allowing Migration of senior citizens;
(3) If reply to item 1 is yes then (a) please provide copy of new premium table under Mediclaim 2013 applicable to policy holders who opted to stay with Mediclaim 1996, (b) Please inform if 2.5% increase per year above age 70 years will continue or not;
(4) Please provide copy of policy documents for mediclaim 2013 and prospects of Mediclaim 2013,
(5) Please provide copy of Loading of Premium Conditions under mediclaim 2013;
(6) Please inform maximum increase in premium allowed for senior citizens;
(7) Please inform additional features provided by insurance company for allowing them to withdraw old product and introduce new production mediclaim 2013; and
(8) copy of approval letter with term and conditions given by IRDA for Mediclaim 2013.
2. The CPIO (Health) vide letter dated 23.10.2013 replied to the appellant in response to Point 1 that the query was not clear and advised the appellant to refer the terms and conditions of the policy document. In response to Point 2 to 8 the CPIO informed the appellant that there was no product named ‘Mediclaim 2013’ approved by IRDA. Hence no information could be provided on these queries. Aggrieved with the reply of the CPIO the appellant preferred appeal on 25.10.2013 before the FAA. The FAA vide order dated 2.12.2013 held that the product referred in appellant’s application by typographic mistake, has been stated as Mediclaim 2013 instead of Mediclaim 2012. The FAA remitted the matter to the CPIO with direction to process the application afresh in reference to Mediclaim 2012 of M/s. New India Assurance Co. Ltd. In compliance with directions of the FAA, the CPIO vide letter dated 18.12.2013 replied to the appellant as follows: (1) The information sought was not clear and insufficient. The date of the option exercised was not mentioned; (2) and (3) – not applicable, (4) & (5) Copy of Policy document and prospectus of Mediclaim 2012 provided to the appellant; 4(A) Copy of premium chart for Mediclaim 2007 and Mediclaim 2012 provided to the appellant; 5(B) the information sought was not clear and insufficient. The date of the option exercised was not mentioned; (7) The information sought was not clear; (8) Copy of approval letter for Mediclaim 2013 provided to the appellant.
3. Thereafter the appellant preferred the present appeal before the Commission stating that he did not wish to state that IRDA had provided incorrect documents but in public interest of policyholders IRDA should put on their website that IRDA has not checked compliance of Policy Documents and/or Prospects with New Health Policy 2013 requesting policyholders to check policy documents received by them.
4. The matter was heard by the Commission. The appellant reiterated that IRDA should put on their website that IRDA has not checked compliance of Policy Documents and prospects with New Health Policy 2013 requesting the policyholders to check policy documents received by the for compliance. The respondents stated that information as per available records had been provided to the appellant.
5. Having considered the submissions of the parties, the Commission observes that the respondents provided information as per available records to the appellant. However, in view of above submissions of the appellant, the Commission recommends to put New Health Policy 2013 approved by IRDA on their website, if not already done. The appeal is disposed of.
Citation: Shri Shantaram Walavalkar v. Insurance Regulatory & Development Authority in Appeal: No. CIC/MP/A/2014/000696