When did the IRDAI mandate the issuance of a standardised CIS?

The mandate came into effect on January 1, 2024.

Why is a standardised CIS important?

It promotes transparency, helps customers understand policy details, and eliminates information asymmetry between insurers and policyholders.

What key elements are included in the CIS?

The CIS includes product name, UIN number, policy term, sum insured, cumulative bonus, key benefits, exclusions, co-payment clauses, claims process, obligations, and contact details for grievances.

How does the CIS help in claim settlements?

By providing clear information about the claims process, documentation required, and TAT for settlement, the CIS helps prevent disputes and misunderstandings.

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New Health Insurance Rule | Customer Information Sheet - Digitization, Standardised & Benefits

Q: What is a Customer Information Sheet (CIS)?

A CIS is a 2-3-page document provided by insurance companies, summarising key details about a health insurance policy in simple language.

Alankar Mishra

Author

Updated: 28-01-2025 at 6:10 AM

New Health Insurance Rule | Customer Information Sheet - Digitization, Standardised & Benefits

Since January 1, 2024, buying or renewing a health insurance policy has gotten much simpler for Indian consumers. In a landmark policy directive, the Insurance Regulatory and Development Authority of India (IRDAI) has mandated all general and health insurance providers to issue a standardised Customer Information Sheet (CIS) to customers.

These 2-3-page CIS forms are written in simple language and will capture all key details regarding the policy on offer. The provision is based on the regulatory principle of utmost good faith and aims to promote transparency for policyholders.

Let’s understand the new health insurance rules in-depth, along with their benefits.

What Is A Customer Information Sheet (CIS) Of A Health Insurance Policy?

A Customer Information Sheet (CIS) is a significant part of a digital health insurance policy which is a summary given to the policyholders outlining every important information about their respective health insurance policies. CIS forms help the policyholders understand everything about their policies without needing to go through a complex booklet.

Latest Rules On CIS (Customer Information Sheet)

As per the latest rules, it is now compulsory for all health insurance companies to provide people with a Customer Information Sheet to make things easier for the people. Apart from this, several other rules have been introduced like:

Any death claims have to be settled within 15 days if there is no investigation going on. If an investigation is required, the settlement should be complete within 45 days.
Partial withdrawal requests should be settled within a week.
Benefits related to the maturity of the policy, annual payouts, and income should be made on the due date of the policy.
Insurers are encouraged to use cashless claims rather than cash-based claims. Cashless transactions would be made within an hour of the claim.
If the policyholder dies during ongoing treatment, the body of the deceased shall be given to their family immediately and a claim settlement should be made.

Features Of The CIS

Several features of the Customer Information Sheet outline its purpose. Some of its key features are mentioned below:

Summary: CIS forms serve the role of a summary designed to help the policyholders understand their policy. It comprises all key components regarding the health insurance policy.
Complaints: If the policyholder has any complaints, the Customer Information Sheet also lays out the procedure that they can follow and file a complaint.
Range of information: CIS forms comprise key details about the health insurance policy like total sum, premium details, waiting periods for certain treatments, etc.

Need For Standardised CIS In Digital Health Insurance

Historically, health plans in India have been renowned for complex exclusions and technicalities that keep customers unaware of complete coverage terms. Varying policy wordings and clauses often led to disputes during claim settlement.

To eliminate information asymmetry between insurers and the insured, IRDAI first introduced the concept of a Customer Information Sheet (CIS) in 2017 across life, non-life, and standalone health insurance products. However, a lack of standardisation could have helped transparency.

The latest circular aims to develop uniform CIS guidelines exclusively for retail health policies sold by general and health insurance companies. By serving as an acknowledgement document summarising policy features, the CIS form will prevent future disputes due to a lack of transparency.

It will also enable easier comparison across health plans while buying or porting policies.

Key Components Of The CIS (Customer Information Sheet)

As per IRDAI guidelines, the CIS forms need to be issued in the policyholder’s preferred language and include the following details:

Product name, UIN number, policy term, sum insured, and cumulative bonus.
Key health insurance benefits are covered, e.g., hospitalisation, pre- and post-care, and AYUSH treatment.
List of permanent exclusions like suicide, cosmetic surgery, alcohol abuse, etc.
Co-payment clauses, sub-limits if applicable.
Claims intimation process, document list, TAT for settlement.
Obligations of the insurer and policyholder.
Contact details for disputes and consumer grievance redressal.
Besides simplifying policy comparisons, the Customer Information Sheet will ensure customers make informed purchasing decisions aligned to their needs.

Digitization Of CIS Delivery Via Repository

As part of the reforms, the issuance and delivery of CIS forms will be done digitally by insurance repositories regulated by IRDAI.

Policy buyers can access and download standardised Customer Information Sheet in real-time through the repository’s web portal or mobile app as insurers integrate with the digital system.

This will automate the storage of CIS forms, giving customers hassle-free access to their policy information at any time, even if they switch insurers in the future.

The move accelerates India’s adoption of e-documentation in the insurance sector.

Benefits Of Standardised CIS Forms

The mandatory standardised CIS forms for digital health insurance aim to provide the following benefits:

Aid easy comprehension of covers and exclusions by policyholders
Eliminate a lack of transparency about claim settlements.
Curb mis-spelling of products unable to serve needs
Simplify comparisons across health plans.
Increase trust and insurers’ accountability.
By serving as the single point of reference, the Customer Information Sheet will give customers greater clarity on policy details and rights as insured citizens.
This furthers the insurance regulator’s consumer protection mandate.

Way Forward

The CIS guidelines help move towards a more transparent and efficient way of working to help the insurers better understand the complete framework of the insurance they will undertake.

This also provides them with a tool to compare and contrast to choose the best policy and plan available to them. The CIS guidelines will further encourage people to seek out insurance policies, as they have been simplified and made more accessible than before.

Stay updated with Jaagruk Bharat to get the latest information on government healthcare schemes and more, and reach out to us via our community page if you have any questions.