IRDAI has set new health insurance rules. Here’s what you should know

All new policies being launched have to comply with these new guidelines. Existing policies have to make amendments by October 2020.

IRDAI has set new health insurance rules. Here’s what you should know

The Insurance Regulatory and Development Authority of India (IRDAI) has put forward new regulations in an effort to transform health insurance policy in India. New health insurance rules ring good news for the insured as changes comprise doing away with exclusions and reducing ambiguity. 

Any health insurance policy to be launched from October 2019 will have to adhere to these new regulations. Existing health insurance plans will have to make changes to accommodate the same by October 2020.

Related: 5 Best Health insurance plans in India 

What are the new rules? 

Here are the guidelines that have been put in motion and what they mean for the common man.

Certain diseases to be treated as pre-existing in the first three months of diagnosis: As per this, the definition of pre-existing diseases has been modified to include ailments diagnosed within the first three months of buying a health insurance policy.  This is in addition to the previous definition that includes any condition that exists at the time of buying health insurance. This move will help insurance providers curtail fraud.

Exclusions are no longer allowed: This essentially means that insurance providers can no longer deny claims or refuse to give health insurance policies based on exclusions. These include mental illnesses, psychological disorders, age-related diseases, injuries due to working in dangerous environments such as coal mines, etc. This will help bring in health inclusion.

Set 16 permanent exclusions listed: IRDAI has also specified a list of 16 diseases that are permanently excluded. These include epilepsy, Hepatitis B, chronic kidney disease, etc. An insurance company can choose to offer health insurance to people that have these diseases, excluding the 16 ailments mentioned. This is actually good news as people will be able to get health insurance for other conditions, and not face outright rejection as is the case now.

Related: Why do you need health insurance? 

Transparent claims process: IRDAI has standardised the health insurance policy document and fine print. There are 18 specific codes and exclusions basis that insurance providers can cite to deny the claim. No other vague reasons can be used. This will help create a transparent process and reduce the number of disputed claims.

Ban of ambiguous words: Vague, open-ended, open to interpretation words can no longer be used by insurance providers in the health insurance policy. This has been done to ensure claims are not rejected on unfair grounds and the insured are not taken for a ride. New rules have also specified that the maximum waiting period for any policy is four years.

The new regulations should help with health insurance inclusion, enhanced coverage and transparent claims processes. There may be a slight increase in premiums in the coming year, but the benefits will definitely outweigh it. Take a look at why insuring your health is a smart decision to get a more comprehensive understanding of health insurance benefits.


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