The standardization norms reduced disputes as all insurers had to follow uniform definitions and clauses.
Health insurance policyholders, existing as well as new, have a reason to cheer in the new financial year. These revisions will be applied to all new policies and integrated into existing ones upon renewal.
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The Insurance Regulatory and Development Authority of India (IRDAI), as part of its product regulations overhaul across insurance segments, has tweaked some crucial norms for health insurance policies.
In April 2024, IRDAI introduced updates to health insurance regulations, emphasising decreased waiting periods and improved claim settlement terms for policyholders.
Here are the key changes in provisions that will affect health insurance policyholders.
- The waiting period for ailments has been shortened from 8 to 5 years, while the waiting period for pre-existing conditions has also been decreased. Additionally, the maximum age limit for purchasing a health policy has been eliminated.
- Till now insurance companies needed to offer regular health coverage to a person upto 65 years of age. By changing rules, the maximum age condition for purchasing a health policy has been removed.
- After completion of 60 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.
- Insurance companies cannot reject claims based on not providing information about pre-existing conditions like diabetes, hypertension, asthma, even if the reason for the policyholder’s hospitalisation was for some other reason.
- Now, the waiting period has been brought down to a maximum of 3 years. This applies to new policyholders only, but existing policyholders will also benefit as their waiting period gets reduced upon renewal to align with the new 3-year limit.
Conclusion
While reduction in waiting and moratorium periods are welcome changes, certain aspects have been left unaddressed. The regulator needs to provide clarity on whether the standardisation of health insurance definitions and rules, which came into effect in 2019, will continue to be applicable.
