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In a major development, IRDAI has done away with the requirement of maximum age limit for insurers to sell health plans.
So far, individuals could buy a fresh insurance policy till 65-years of age. With this, any one regardless of their age can buy a new health policy.
In fact, the insurance regulator has asked health insurers to introduce targeted policies for specific segments like senior citizens. The regulator has also instructed insurers to establish a separate channel to address the health insurance related claims and grievances of senior citizens.
In a gazette notification, IRDAI said, “Insurers shall ensure that they offer health insurance products to cater to all the age groups. Insurers may design products specifically for senior citizens, students, children, maternity and any other group as specified by the Competent Authority.”
The regulator has also directed insurers to issue health policy to individuals with all types of existing medical conditions. With this, insurers cannot deny issuing policies to a person with severe medical conditions like cancer, heart or renal failure, AIDS and so on.
Another important development was revision in the waiting period of pre-existing conditions. IRDAI has reduced the waiting period of pre-existing conditions from 48 months to 36 months. The insurance regulator said that all pre-existing conditions should be covered after 36 months irrespective of whether the policyholder has disclosed or undisclosed it. In simple words, health insurers cannot reject claims citing pre-existing conditions after 36 months.
Further, IRDAI clarified that no claims can be denied after 60 months. “After completion of sixty continuous months of coverage (including portability and migration) in health insurance policy, no policy and claim shall be contestable by the insurer on grounds of non-disclosure, misrepresentation, except on grounds of established fraud.”
Here are other key changes:
Life insurers cannot launch indemnity-based health policies i.e. policies that compensate for hospital expenses. They can only offer benefit-based policies i.e. offering fixed cost on occurrence of a covered disease
Life insurers can bundle health plan with ULIPs
Insurance premium cannot be changed during the policy term. for instance, if a customer pays 3-year premium in advance, insurers cannot seek additional money during the policy tenure i.e. 3 years in this example. however, premium can be changed based on age, risk and so on at the time of renewal
Insurers can offer facility of instalment for payment of premium
Only general and health insurers can offer travel policies
There is no cap on AYUSH treatment. Treatments like Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy systems will get coverage to the extent of sum insured
These changes have come into effect from April 1, 2024.
