What is KYC?

KYC in Health Insurance

KYC, or Know Your Customer, is a process which is used to verify a customer’s identity and assess their suitability for their financial products or services. In the context of Health Insurance, KYC is a necessary process that helps to ensure that the policyholder is genuine and that the policy is being used for the intended purpose.

Why is KYC important in Health Insurance?

Effective 1st Jan 2023, KYC is a mandatory compliance requirement in the health insurance industry going forward, governed by the Insurance Regulatory and Development Authority of India (IRDAI). There are several reasons why KYC is important in health insurance:

TransparencyHealth insurance companies deal with sensitive financial information of customers. As a result, businesses must confirm the validity of their customers’ data, both individuals and organizations. KYC assists insurers in gathering sufficient documentation in order to offer enough insurance coverage to the appropriate claimants.
Fraud preventionOne of the main reasons why KYC is important in Health Insurance is that it helps to prevent fraud. By verifying the policyholder’s identity, Health Insurance companies can ensure that the policy is not being used for fraudulent practices, such as to claim benefits for treatments that were never received.
Risk assessmentKYC is also important in Health Insurance because it helps insurance companies to assess the risk associated with providing coverage to a particular policyholder.By obtaining information about the policyholder’s medical history and current health status, insurance companies can determine the likelihood of the policyholder making a claim and adjust the premiums accordingly.
Customer ProtectionAnother reason why KYC is important in Health Insurance is that it helps to protect the policyholder. By verifying the identity of the policyholder, insurance companies can ensure that the policyholder is receiving the benefits and protections of the policy that they are entitled to.
Regulatory complianceKYC is important in Health Insurance from a regulatory standpoint. Many countries have laws and regulations that require insurance companies to verify their policyholders’ identity and ensure that policies are not being used for fraudulent or illegal practices.Insurance companies can protect themselves and their policyholders from legal and financial risk by complying with these regulations.
Improved customer serviceFinally, KYC is important in Health Insurance because it helps to improve the overall customer experience. By verifying the policyholder’s identity and obtaining relevant information about their medical history, insurance companies can provide more tailored and personalized service to their policyholders.
Policy issuanceThe insurance company will issue a policy to the policyholder by providing a copy of the policy documents, including the terms and conditions of the coverage.
Ongoing monitoringAfter the policy has been issued, the insurance company will continue to monitor the policyholder’s information to ensure that it remains accurate and up-to-date. This may involve collecting additional information as needed and making adjustments to the policy if needed.

What is CKYC?

A central KYC Registry is a repository of KYC records. When an individual submits KYC documents, they are registered in the repository and assigned a unique CKYC number. This CKYC number can be used instead of presenting actual KYC documentation. All financial institutions can use the CKYC repository to check their customers’ KYC information.

Health Insurance Plans Starts at Rs.14/day*

What is the advantage of CKYC?

After registering KYC data with CKYC, you will obtain a 14-digit KYC Identification Number (KIN) that you may use for any financial transaction. You will not be required to submit your KYC documents.

What is the process of completing CKYC?

When you purchase any financial product from any of the financial institutions regulated by RBI, SEBI, IRDAI or PFRDA, you need to submit the following documents:

  • CKYC application form*
  • PAN
  • Identity and Address Proof (Passport, Driving license, Aadhaar number)
  • One recent passport-size photograph

Upon successful registration, you will receive a 14-digit CKYC Identification number. 

In the case of Star Health, the field/disclaimers/information required as per the CKYC form gets captured in our digital application forms itself, hence there is no separate CKYC form required.

How is CKYC beneficial?

Through CKYC, you can quote for any financial transaction, and you don’t have to submit your KYC documents again unless there is a change in your KYC details.

  • One time KYC compliance / updation for all financial relationships
  • Can be used across financial products – banking, insurance, stocks, pops
  • Paperless KYC process
  • No repeat KYC documentation required
  • Your CKYC identifier can be used PAN India

Documents Required for KYC in Insurance

The following documents can be accepted for KYC in insurance:

  1. Identity & address proof document list: 
  2. Passport
  3. Voter ID
  4. Driving license
  5. Proof of possession of Aadhaar
  6. NREGA job card
  7. National population register letter
  • Recent Photograph
  • Pan card / Form 60
  • Address proof document list:

This document need to be selected if your address is different from the POA/POI’s Address (as listed above)

  • Aadhaar
  • Voter ID
  • Passport  
  • Driving license
  • Nrega job card  
  • National population register letter
  • Self-declaration
  • Electricity/telephone/gas/water bill
  • Property or municipal tax receipt
  • Pension payment order (pposs)
  • Letter of allotment from state/central govt
  • Leave & license agreement

Deemed OVD (Official valid document) documents

  1. Utility bill which is not more than two months old of any service provider (electricity, telephone, post-paid mobile phone, piped gas, water bill).
  2. Property or Municipal Tax receipt. Deemed Proof of Address.
  3. Pension or family pension payment orders (PPOs) issued to retired employees by Government Departments or Public Sector Undertakings, if they contain the address.
  4. Letter of allotment of accommodation from employer issued by State or Central Government departments, statutory or regulatory bodies, public sector undertakings, scheduled commercial banks, financial institutions and listed companies. Similarly, leave and license agreements with such employers allotting official accommodation.

How can I update my KYC with Star Health, if I am an existing customer?

We are in process of sending links to our customers through email / SMS for the CKYC updation with the policy records. In case the customer don’t have the CKYC ID#, the new CKYC ID# will be created based on the details and document shared. A 14-digit number is assigned to the customer and is connected to his ID proof. If the customer decides to invest with another financial institution once the process is completed, he/she will not be requested for KYC again unless there is a change.

How can I check if I am CKYC compliant?

You can check your KYC status online by entering details such as DOB, PAN through the various KRAs {KYC Registration Agency} appointed by SEBI. If your status is KYC verified, you are KYC Compliant.

Summing up

In conclusion, the KYC process in Health Insurance involves the following:

  • Verifying the identity of the policyholder
  • Assessing the risk associated with providing coverage
  • Improve Customer Service

By following these steps, insurance companies can ensure that they are providing secure and tailored coverage to their policyholders.


DISCLAIMER: THIS BLOG/WEBSITE DOES NOT PROVIDE MEDICAL ADVICE

The Information including but not limited to text, graphics, images and other material contained on this blog are intended for education and awareness only. No material on this blog is intended to be a substitute for professional medical help including diagnosis or treatment. It is always advisable to consult medical professional before relying on the content. Neither the Author nor Star Health and Allied Insurance Co. Ltd accepts any responsibility for any potential risk to any visitor/reader.

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