IRDAI has proposed standardised guidelines on health policies in which it says that health insurance policies cannot be challenged after eight years of continuous premium payments. Simply put, health insurers will not be able to reject your clients’ claim request after eight years of premium payment.
The move will favour policyholders. For instance, if a health insurance company discovers a person to be suffering from pre-existing conditions after eight years, the company cannot reject the claim.
In life insurance policies, the insurers cannot challenge a policy after three years.
Another proposal that would help policyholders relates to mental health. The insurance regulatory authority has recommended that health insurers include mental illnesses in the existing health insurance policies.
The move will help families who have children with special needs. The medical expenses of such families is usually very high. Apart from a regular medical plan, these families also need special contingency plans for the child. This is because children with special needs were not eligible for medical insurance as they have a pre-existing condition.
Other inclusions include
- Illness or injuries associated with hazardous activities, given that the policyholder did not participate in adventure or a hazardous sport
- Patients on artificial life maintenance
- Puberty and menopause related disorders, age related macular degeneration and neuro-developmental disorders
- Failure to adhere to medical advice or treatment
Exclusions
- Sarcoidosis, epilepsy, malignant neoplasms, inflammatory bowel disease, hepatitis B, Alzheimer's disease, Parkinson's disease, chronic liver and kidney diseases and HIV/AIDS.
Standardisation
In order to make the description of exclusions uniform and specific across the Industry, the guidelines have standardised wordings of some exclusions.
Further, the regulator said that existing health insurance products, which do not comply with these rules, should be withdrawn by April 1, 2020.
IRDAI has asked for the feedback of all stakeholders by May 31 on these proposals.
