New laws to make health insurance user-friendly

The minimum age of entry for buying the policy will be 18 years and the maximum age will be 65 years

October 20, 2019 09:45 pm | Updated October 21, 2019 01:31 pm IST

Doctor checking woman patient arterial blood pressure. Health care.

Doctor checking woman patient arterial blood pressure. Health care.

In order to make health insurance available to all, the Insurance Regulatory and Development Authority of India (IRDAI) recently introduced certain new laws in order to make health insurance more user-friendly.

To start with, a committee report that restricts exclusions under a health insurance policy has been introduced which are completely customer-friendly. Specifically, IRDAI issued a draft to introduce a standard health insurance plan for all with a basic sum insured of ₹50,000 to ₹10 lakh, as per the requirement of the customer.

The minimum age of entry for buying the policy will be 18 years and the maximum age will be 65 years. The plan will be indemnity-based with lifelong renewability option.

Alternative medicine

IRDAI also mandated that the standard health insurance plan will also provide coverage for expenses incurred on alternative treatment such as AYUSH, which includes homeopathy, ayurveda, siddha or unani. The expenses, though, will completely be subject to fixed and standard sub-limits on the sum insured.

Another major proposal submitted is a four-year waiting period for inclusion of any ailment in the health cover against the current waiting period which is for two years. However, for some conditions such as hypertension, diabetes and cardiac problems, the waiting period must be reduced to 30 days. Moreover, in order to ensure that the people suffering from pre-existing diseases, including those with disabilities, get proper health insurance, the insurers will include permanent exclusions with due consent of the customer.

Also, insurers will not be allowed to question the claims of the policyholder on the ground of non-disclosure. However, this will only be applicable after eight years of continuous renewals by the policyholder. However, the policy would be entirely subject to all clauses, including sub-limits, co-pay and deductibles as mentioned in the policy contract.

Mental health

With the aim of making mental healthcare available to all, IRDAI has directed insurers to include mental illnesses to be included in all regular health insurance policies. IRDAI made it quite clear that insurers cannot deny coverage to policyholders who have used opioids or anti-depressants in the past. Also, insurers cannot deny coverage to people with a proven history of clinical depression, personality or neurodegenerative disorders, sociopathy and psychopathy.

It was often noted that a certain group of patients including cancer survivors, epilepsy patients and many others with specific permanent physical disabilities are denied medical coverage due to their severe health conditions.

Further, all health conditions and illnesses acquired after the issuance of policy, apart from those not covered under the policy contract (like infertility and maternity), will now be covered under the policy. There are numerous major ailments that cannot be permanently excluded.

Some of the important and major diseases that must be added to the list include Alzheimer’s, Parkinsons, AIDS/HIV and morbid obesity.

With all these changes in place, it is a good time to review your insurance portfolio and make sure that all health related risks are covered by the insurer.

(The author is Business Head, Health Insurance,

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