In order to guarantee that there is more coverage and that no one is turned away from the facility, Irdai is pressuring businesses to make sure that health insurance is offered to all age groups, as well as people with pre-existing conditions, mental health concerns, and women.
Sources informed TOI that instead of imposing specific guidelines, Irdai will keep an eye on how businesses react to the most recent laws.
Making sure the right products reach the market is the goal. According to a source acquainted with the discussions inside the Hyderabad-based regulatory agency, “The regulator has left it up to the market to decide the premium and other elements to address the requirements of the wider public.”
A new rule aims to increase insurance accessibility.
Up until now,health care have frequently refused to provide health coverage to first-time customers who are over 60 and, even for the younger market, they frequently refuse to renew coverage if a claim is filed. Although insurers must offer health insurance that can be renewed indefinitely, they are not required to give insurance to those purchasing insurance for the first time after the age of 65. Many insurance companies set a 65-year-old maximum age of admission, while some—like Star Health—accept applications from even older individuals.
The majority of people avoid purchasing health insurance because they are confused by the terms and conditions, particularly when it comes to waiting periods and pre-existing diseases. The regulator’s goal with these new standards is to guarantee uniformity so that citizens’ lives are easier when it comes to comprehending health insurance. According to Tapan Singhel, MD & CEO of Bajaj Allianz General Insurance, “The new regulation aims to make health insurance even more inclusive, especially for senior citizens, people with disabilities, and people with chronic ailments.”
According to sources, businesses are not yet required to provide policies to everyone. Underwriting a first-time buyer of, say, 90 would be difficult, according to insurers, because the higher risk would drive up the cost of the coverage unnecessarily. Companies are already dealing with a problem of healthy seniors leaving their insurance after the age of 75 whose premiums exceed 20% of the total amount insured.
IRDAI eliminates the age limit for purchasing health insurance
With effect from April 1, 2024, the Insurance Regulatory and Development Authority of India (IRDAI) has removed the age limit for acquiring health insurance coverage.
Before, people could only get new insurance plans up until the age of 65. But because to recent adjustments that took effect on April 1, 2024, anyone can now get new health insurance, regardless of age.
“Insurers need to make sure that all age groups are catered for in their health insurance offerings. According to an IRDAI statement, “They may design products specifically for senior citizens, students, children, maternity, and other groups as specified by the Competent Authority.”
The insurance regulatory body’s action intends to encourage insurance carriers to expand their product offerings and to build a more inclusive healthcare environment in India.
In addition, IRDAI has instructed health insurance companies to create plans specifically designed for certain groups of people, such older folks, and to set up channels specifically for resolving their complaints and claims.
This is a positive development because it gives those over 65 more options for obtaining health insurance. Underwriting rules set by the board allow insurers to cover policyholders over 65. According to an industry analyst, “The coverage is subject to offer and acceptance between the Insured and the Insurer based on viability for Insurers and affordability for Senior Citizens.”
In addition, insurers cannot refuse to provide coverage to people with serious medical illnesses such as AIDS, cancer, heart failure, or kidney failure as a result of the recent warning.
The notification states that IRDAI has shortened the 48-month waiting period for health insurance to 36 months. After 36 months, all pre-existing conditions should be covered, whether or not the policyholder initially revealed them. Stated differently, following these 36 months, health insurers are not allowed to deny claims on the grounds of pre-existing conditions.
Moreover, the introduction of indemnity-based health policies by insurance firms that cover hospital costs is prohibited. Rather, they can only sell benefit-based policies that have set costs in the event that a covered illness manifests.
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