New Health Insurance Policy Rules for senior citizen
- Even those above 65 years of age will now be able to buy health insurance easily, as the age gap on health insurance policy has been removed.
- IRDAI has directed health insurance companies to come up with special policies keeping senior citizens in mind and also to create a robust system for quick disposal of complaints related to their policies.
- The move will help senior citizens get cashless treatment easily in hospitals.
- IRDAI has also asked health insurance companies to come up with special health insurance policies pertaining to maternity and for students and children.
- Health insurance companies will no longer be able to refuse coverage to people suffering from pre-existing medical conditions like cancer, heart or kidney failure, AIDS etc.
- As premiums for a special policy can be higher than a normal policy, the policy holders will have the option to pay the premium in instalments.
- There will be no cap on the treatment of AYUSH i.e. Ayurveda, Yoga, Naturopathy, Unani, Siddha, Homeopathy, and one can get coverage for the entire sum insured.
- IRDAI has also reduced the waiting period for new policy holders from 48 months to 36 months. Now all, pre-existing health conditions will be covered after 36 months – whether the policy holder has disclosed the disease at the time of taking the policy or not.
- Until now, insurance companies not just cancelled claims on non-disclosure, but also cancelled the entire policy. Now the moratorium period has been reduced from 8 years to 6 years.
- Moratorium period is the duration after which the insurer cannot deny the claim provided it is not a fraudulent claim.
- According to IRDAI, the rule has been implemented from April 1, 2024.
- As per the new norms, on completion of the waiting period, diseases/treatments will be covered provided the policy has been renewed without any break.
- The time-frame for defining pre-existing disease has also been set to three years in the new regulations.
- Pre-existing disease refers to any health condition, ailment, injury or disease diagnosed by a physician not more than three years prior to the commencement of the policy or for which medical advice or treatment was recommended or received from a physician not more than three years prior to the date of policy issue.
- AYUSH (Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy systems) treatment coverage is another aspect emphasised in the new norms.
- Mandating a Board approved policy for the insurers, the regulator wants insurance companies to treat AYUSH on par with other treatment options.
- The regulator has also advised insurers against denying renewal of a health insurance policy on the ground that the insured had made a claim or claims in the preceding policy years, except for benefit based policies where the policy terminates following payment of the benefit covered under the policy such as in the case of a critical illness policy.
Objectives of New Insurance Regulations
- To enable provisions for insurers to respond faster to emerging market needs, improve ease of doing business and enhance insurance penetration while ensuring protection of policyholders interests.
- To encourage insurers to conform to good governance while designing and pricing their products.
- To reduce the “specific waiting period” from four years to three years.
- From the time the policy is purchased, to get insurance cover for specified diseases/treatments (except due to an accident).