The Insurance Regulatory and Development Authority of India (IRDAI) has recently introduced new regulations that are transforming the health insurance landscape in India. These changes are designed to make health insurance more accessible and beneficial for everyone, regardless of age or pre-existing health conditions.

Here is an in-depth look at the new regulations and what they mean for consumers.

Extended Coverage for Senior Citizens

In a groundbreaking move, effective April 1, 2024, IRDAI has abolished the age limit previously set at 65 years for purchasing health insurance. This means individuals of any age can now secure health insurance, ensuring that the elderly population, often the most in need of medical attention, is not left unprotected. This change is expected to significantly widen the reach of health insurance and provide peace of mind to all age groups.

Inclusion of AYUSH Treatments

In a move to embrace traditional forms of medicine, the IRDAI has mandated that there should be no cap on the coverage of AYUSH treatments, which includes Ayurveda, Yoga, Unani, Siddha, and Homeopathy. This decision broadens the scope of health insurance policies, allowing policyholders to seek alternative treatments under their health insurance plans.

Moratorium Period Reduction

The moratorium period, which refers to the duration after which an insurer cannot deny a claim on the grounds of non-disclosure, has been reduced from eight years to five years. This means that policyholders can have greater peace of mind, knowing that their claims cannot be rejected for reasons other than proven fraud after five years of continuous coverage.

Coverage for Pre-Existing Conditions

Another significant update is the reduction of the waiting period for pre-existing diseases. Previously set at four years, it has now been shortened to three years. This means that policyholders who have paid premiums for three years cannot have their claims rejected based on pre-existing conditions. Furthermore, after 60 months of continuous coverage, claims cannot be contested by the insurer on the grounds of non-disclosure of such conditions, barring cases of proven fraud.

Introduction of the Bima Sugam Platform

Bima Sugam, a new digital interface, has been launched by IRDAI to facilitate the comparison and purchase of insurance policies online. This platform is designed to make the insurance buying process more user-friendly & accessible.

Consolidated Regulatory Framework:

IRDAI has merged several regulations into a single, unified structure known as the IRDAI (Protection of Policyholders’ Interests and Allied Matters of Insurers) Regulations, 2024. This consolidation aims to ensure fair treatment of individuals during the solicitation and sale of insurance policies and to protect policyholder interests throughout their engagement with insurers.

Flexibility in Premium Payment

The IRDAI has introduced regulations that allow policyholders to pay their premiums in installments, providing much-needed financial flexibility. This move is particularly beneficial for those who may find it challenging to pay a lump sum amount annually.

Specialized Channel for Senior Citizen Grievances

Recognizing the unique challenges faced by senior citizens, the IRDAI has established a specialized channel for handling their complaints and claims. This ensures that senior citizens’ grievances are addressed promptly and effectively.

Customer Information Sheet

 The IRDAI mandates that insurers provide a Customer Information Sheet (CIS) that details the policy type, coverage specifics, waiting periods, limits, sub-limits, exclusions, the free-look period, portability options, and guidance on claims submission procedures in an easy-to-understand format.

Conclusion

The IRDAI’s new health insurance rules reflect its commitment to making health insurance more accessible, inclusive, and user-friendly. By focusing on the needs of senior citizens, embracing traditional medicine, reducing waiting periods for pre-existing conditions, and providing financial flexibility, the IRDAI is paving the way for a more secure and health-conscious future for all policyholders.

For those considering purchasing a new health insurance policy or updating an existing one, it’s crucial to understand these changes thoroughly. Policyholders are encouraged to review their policies, clarify any doubts, and ensure they are well-informed about the terms and conditions of their health insurance.