The health insurance sector in India has seen rapid growth in the past few years. The wide scope of growth that this sector has seen, shines light on two key points:

  • People are getting serious about their healthcare expenses
  • A lot of population is still not insured

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According to a recent report of NHP (National Health Profile), only 27 percent of the people in India have health insurance. This means, out of 135 crore people, over 90 crore people have no cover against the herculean healthcare expenses. Be it individual or health insurance plans for family; insurers are still struggling to garner the attention of their customers.

To tackle this problem, the IRDAI (Insurance Regulatory and Development Authority) established a panel that proposed certain changes in the health insurance policy rules. These changes are primarily focused on making the policies more attractive to consumers. In this article, we are throwing light on the changes that the proposal of this committee will bring in the traditional health insurance policies.

  1. Shorter Waiting Period

According to the new guidelines proposed by IRDAI, insurers will no more be able to work around the waiting period. Earlier, insurers could extend waiting period according to their preferences for diseases like diabetes, hypertension and cardiac conditions.

However, now the cap has been reduced to 30 days unless the conditions stated above are pre-existing.

  1. Mandatory Coverage

IRDAI’s new guidelines suggested that insurance companies will not be allowed to question the claim process on the basis of non-disclosures if the policy has had continuous renewals for 8 years. This means, if a policyholder has been continuing the policy for 8 years with an insurer, the claim process won’t be denied in case of any minor mistake made while filing the policy documents at the inception of the plan.

This new rule will ease the policyholder’s concerns about rejection of claim after paying the premium for years. The policy will; however, be subject to all co-payment and sub-limit clauses and deductibles mentioned in the policy contract.

  1. Standardising Definition of Pre-Existing Diseases

The new guidelines will also ensure that the exclusion of different diseases will not be permanent. It means all health problems acquired after purchasing the policy (other than the ones mentioned in the policy) will be covered by the insurer. Exclusion of medical conditions like Parkinson’s Disease, Alzheimer’s, Morbid Obesity and AIDS will not be permitted for long.

  1. Coverage for Individuals with Severe Health Conditions

Except for a few reputable insurers, many insurance companies often deny coverage facility to many cancer survivors and epilepsy patients due to absurd reasons. Considering this, the panel has suggested that insurers will have to provide health coverage to such individuals. However, the condition that the insured person’s specific pre-existing ailments will not be covered remains the same.

The report provided by the panel listed 17 different diseases that qualify in this clause. It includes ailments like epilepsy, valvular and congenital heart diseases, HIV and kidney diseases.

  1. Cover for Advanced Medical Treatments

The panel has also suggested a formation of Health Technology Assessment Committee. This committee will decide the inclusions and exclusions of the modem and advanced medical treatments provided in the Indian market.

Once the committee comes under effect, insurers will not be able to exclude advanced treatments that will be in the list provided by the panel. Moreover, the panel has also issued a guideline that insurers are not allowed to reject claims on peritoneal dialysis and oral chemotherapy.

‘Summing Up’

Starting from health insurance plans for the family to individuals, the new mandates will prove beneficial for the policyholders. The revisions are likely to make the insurance coverage and policy more comprehensive and helpful. Thus, increasing the involvement of more and more people.