5 Steps Taken by IRDAI To Make Health Insurance Consumer-Friendly

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

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


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

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

Shorter Waiting Period

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

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

Mandatory Coverage

IRDAI’s new guidelines suggested that insurance companies will not be allowed to question the claim process based on non-disclosures if the policy has had continuous renewals for eight years. This means that if a policyholder has been continuing the policy for eight 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 plan’s inception.

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

Standardizing Definition of Pre-Existing Diseases

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

Coverage for Individuals with Severe Health Conditions

Except for a few reputable insurers, many insurance companies often deny coverage facilities to many cancer survivors and epilepsy patients due to absurd reasons. Considering this, the panel has suggested that insurers must provide health coverage to such individuals. However, the condition that the insured person’s 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.

Cover for Advanced Medical Treatments

The panel has also suggested the formation of the 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 exclude advanced treatments that will be in the list provided by the panel. Moreover, the board has also issued a guideline that insurers cannot reject claims on peritoneal dialysis and oral chemotherapy.

‘Summing Up’

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

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