Insurance is a financial arrangement where individuals or organisations pay a certain amount of money, called a premium, to an insurance company in exchange for protection against financial losses or risks. In simpler terms, it's like a safety net that helps you handle unexpected expenses or damages without having to bear the full financial burden yourself. 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 for or reimburses the cost of medical treatments, surgeries, hospital stays, medications, and other healthcare services outlined in your policy.
In India, these insurances are governed by the Insurance Regulatory and Development Authority of India (IRDAI). On January 23, 2024, the IRDAI announced in a press release that as a part of a larger effort to simplify and improve regulations in the insurance industry, the organisation is making some changes to the existing rules. These changes aim to make regulations clearer, reduce paperwork for insurance companies, and make sure they follow the rules while also adapting to changes in the business world. So what does it means for the policyholders or those who have or will purchase health insurance?
IRDAI Changes Health Insurance Policy
The recent updates from IRDAI have brought significant changes to health insurance regulations. Here’s a summary of the new guidelines under 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 medical coverage.
Reduced Waiting Period for Pre-existing Diseases
The waiting period for covering pre-existing diseases is now reduced to 3 years, down from the previous 4 years, making it easier for policyholders to claim treatment costs for conditions like 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, enabling quicker claims for these treatments.
Coverage for Severe Medical Conditions
Insurers are now required to issue health policies to individuals with severe pre-existing conditions like heart disease, cancer, renal failure, and AIDS, making medical 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 insured limit, as sub-limits are removed.
Also Read: IRDAI Mandates Covering Mental Illnesses In Health Insurance
Customised Plans for Specialised Groups
Insurers must design customised health insurance products for groups like senior citizens, children, maternity, students, etc, to meet specific needs.
Dedicated Support for Senior Citizens
Insurers are directed to create a specialised channel to handle claims and complaints of senior citizens, ensuring better support and resolution for their concerns.
Reduced Moratorium Period
The moratorium period in health insurance is reduced to 5 years from 8 years, preventing claim rejection based on non-disclosure or misinterpretation after continuous coverage of 5 years unless fraudulent.
Benefit-based Policies Only
Insurers can only issue benefit-based policies for hospitalisation expenses, eliminating indemnity-based policies.
Multiple Claims Across Insurers
Policyholders with benefit-based policies can file multiple claims with different insurers, offering more flexibility and options during illness.
Also Read: Learn How To Choose a Health Insurance Plan That Will Cover Your Diabetes
Health insurance can be a beneficial tool if used correctly. For that, it is a must that you are aware what benefits are owed to you and which insurance policies to chose. With these changes, the IRDAI aims to make health insurance more inclusive, reduce uncertainty, and increase trust among policyholders, ultimately boosting insurance coverage in India, and making it more equitable and inclusive.