IRDAI Introduces Health Insurance updates on Regulations Effective from April 1st, 2024

The Insurance Regulatory and Development Authority of India (IRDAI) has rolled out new regulations aimed at enhancing the efficiency and transparency of health insurance policies in India. These regulations, effective from April 1st, 2024

Pre-Existing Diseases Waiting Period Restriction: Previously, the definition of pre-existing diseases allowed for a waiting period of up to 48 months, but with the new regulations, this waiting period has been capped at 36 months. This means that insurers cannot impose a waiting period of more than 36 months for pre-existing diseases, aligning with the standard definitions provided by IRDAI. For new policies, this maximum waiting period of 36 months for pre-existing diseases will be applicable from the outset. Meanwhile, for existing policies, the waiting period will automatically reduce to 36 months upon renewal.

Coverage of Pre Existing Ailments: Another noteworthy aspect of the development is the mandate for insurers to offer coverage to individuals with pre-existing medical conditions, such as cancer, heart or renal failure, and AIDS. This provision provides much-needed relief to those with existing health challenges, ensuring they have access to essential insurance coverage. This change aims to provide policyholders with quicker access to coverage for pre-existing conditions.

Moratorium Period Reduction: Another significant change introduced by IRDAI is the reduction of the moratorium period from 96 months to 60 months. This means that after continuous renewal for 60 months, insurers cannot contest health insurance claims based on non-disclosure in the proposal form, unless fraud is proven. It's important to note the distinction between fraud and non-disclosure. Insurers will need to demonstrate that the non-disclosure was intentional and aimed at deceiving the insurer for personal gain to contest a claim after the 60-month period. However, innocent omissions or mistakes in disclosing information cannot be used to contest claims beyond this period.

Age cap removed, those above 65 yrs. too can buy health insurance: I view the recent development in the Indian Insurance Market with great optimism. The removal of the age cap for purchasing health insurance policies is a significant step towards creating a more inclusive and accessible healthcare system in India. Previously, the age restriction of 65 years posed a barrier for senior citizens to obtain comprehensive health coverage, leaving them vulnerable to the financial burden of medical expenses. By abolishing this limitation, the Insurance Regulatory and Development Authority of India (IRDAI) has opened doors for individuals of all ages to secure adequate protection against unforeseen healthcare costs. Furthermore, the directive for insurers to offer health insurance products tailored to different age groups, including senior citizens, is commendable. This ensures that insurance solutions are designed to meet the specific needs and requirements of different segments of the population.

Premium Payment: The flexibility introduced in premium payment options, including instalment payments, adds to the convenience and affordability of health insurance for policyholders. The inclusion of AYUSH (Ayurveda, Yoga, Naturopathy, Unani, Siddha, and Homeopathy) treatments without any coverage cap is also a positive step towards promoting holistic healthcare practices. Additionally, the provision allowing policyholders with benefit-based policies to file multiple claims with various insurers enhances flexibility and options, offering greater choice and control over healthcare decisions.

Overall, these regulatory changes reflect a proactive approach by IRDAI towards addressing the evolving needs of the Indian population and ensuring that health insurance remains accessible, comprehensive, and responsive to the diverse healthcare requirements of individuals, particularly senior citizens. As an insurance consultant, I see these developments as a significant stride towards achieving universal healthcare coverage in India.