Insurance is a financial arrangement in which individuals or organizations pay a certain amount of money, called a premium, to an insurance company in exchange for protection against financial risk or loss. In simpler terms, it’s like a safety net that helps you handle unexpected expenses or damage without having to bear the full financial burden. Insurance can be of many types, one of which is health insurance that covers medical expenses. When you have health insurance, the insurance company pays or reimburses the cost of medical treatments, surgeries, hospital stays, drugs, and other health care services described in your policy.
In India, these insurances are regulated by the Insurance Regulatory and Development Authority of India (IRDAI). On January 23, 2024, the IRDAI announced in a press release that as part of a larger effort to simplify and improve insurance industry regulations, the organization is making some changes to the rules existing These changes aim to clarify regulations, reduce paperwork for insurance companies and ensure they follow the rules while adapting to changes in the business world. So what does it mean for policyholders or those who have or will purchase health insurance?
The IRDAI modifies the health insurance policy
The recent IRDAI updates have brought significant changes in health insurance regulations. Here is a summary of the new guidelines in the IRDAI (Insurance Products) Regulations 2024, effective from April 1, 2024:
No age limit for health insurance
The IRDAI removed the maximum age limit for buying health insurance, allowing people of all ages to purchase health cover.
Reduced waiting period for pre-existing illnesses
The waiting period for cover for pre-existing conditions is now reduced to 3 years, compared to the earlier 4 years, making it easier for policyholders to claim treatment costs for conditions such as diabetes and hypertension.
Reduced waiting period for specific diseases/procedures
The waiting period for specific diseases or procedures, such as joint replacement surgery, is also reduced to 3 years from 4 years, allowing a faster claim for these treatments.
Coverage for serious medical conditions
Insurers are now required to issue health policies to people with serious pre-existing conditions such as heart disease, cancer, kidney failure and AIDS, making health insurance more inclusive.
No sub limits on AYUSH treatments
Policyholders can now claim the full cost of treatments under Ayurveda, Yoga, Naturopathy, Siddha, Unani and Homeopathy systems up to the sum assured limit as sub-limits are removed.
Read also: IRDAI mandates for coverage of mental illnesses in medical insurance
Customized plans for specialized groups
Insurers need to design customized health insurance products for groups such as senior citizens, children, maternity, students, etc., to meet specific needs.
Dedicated support for the elderly
Insurers are directed to create a specialized channel to attend to the claims and complaints of the elderly, guaranteeing better support and resolution of their concerns.
Reduced moratorium period
The health insurance moratorium period is reduced to 5 years from 8 years, preventing claim rejection for non-disclosure or misinterpretation after 5 years of continued coverage, unless fraudulent.
Benefit-based policies only
Insurers can only issue benefit-based policies for hospitalization expenses, eliminating indemnity-based policies.
Multiple claims between insurers
Policyholders with benefit-based policies can file multiple claims with different insurers, offering more flexibility and options during illness.
Read also: Learn how to choose a health insurance plan that covers your diabetes
Health insurance can be a beneficial tool if used correctly. For this reason, it is essential that you know which benefits are owed to you and which insurance policies to choose. With these changes, IRDAI aims to make health insurance more inclusive, reduce uncertainty and increase confidence among policyholders, ultimately increasing insurance coverage in India and making it more equitable and inclusive
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