Changes Introduced by IRDAI With Regards to Health Insurance

Health insurance is no longer an insurance option to contemplate buying, but instead, a must-have for all. The rise in the various ailments makes it a protection cover that you should not miss. Further, digitisation in the country has made it easier to purchase online health insurance plans. All these plans are required to follow some guidelines prescribed by the regulator, Insurance Regulatory and Development Authority of India (IRDAI).

In October 2020, the regulator decided to amend a few of those guidelines. These amendments simplify buying health insurance plans providing more comprehensive cover at an affordable price. This article mentions the changes introduced by IRDAI with regards to health insurance plans –

#1 More coverage for ailments are included

The amendments include coverage for ailments that were otherwise not included under health insurance. Mental illness due to hazardous activity (for example, factory workers in contact with harmful chemicals), genetically caused ailments, puberty and menopause-related treatments, and more are now covered under health insurance plans. Moreover, ailments which have specific waiting periods need to be mentioned with their respective durations.

Impact for you, the policyholder: This additional coverage will ensure a broader coverage and that more people can afford treatment for these ailments under their health insurance cover. For instance, mental ailments require expensive treatments and people often have a stigma around it. Now that your health insurance plan includes mental ailment, any medical issues can be addressed without worrying about finances.

#2 Change in definition of pre-existing ailments

The amendment brings about a change in the definition of pre-existing ailments where the new guidelines specify pre-existing ailments as those that are diagnosed 48 months before issuing the health insurance policy.

Impact for you, the policyholder: Since the earlier definition of pre-existing diseases has been amended to clarify the coverage, it has become hassle-free as the chances of a claim getting rejected have reduced.

#3 Settlement or Rejection of claims within 30 days

The change brought about by the regulator ensures the claims whether accepted or rejected are settled within a definite timeline of 30 days from the date of application. Also, if the insurer delays the payment, 2% penal interest has to be paid above the bank rate of interest.

Impact for you, the policyholder: Due to the increase in healthcare treatment, these delays significantly impacted your finances. Now with the amendment, you can rest assured about legitimate claims being settled within 30 days from its application.

#4 Claims not to be rejected after 8 years

New regulations clarify that if the premium is paid for 8 or more years, the claim cannot be rejected for the various types of health insurance applications. No insurer is allowed to re-evaluate the policy once you have paid the premium for 8 years.

Impact for you, the policyholder: Honest claims made by you cannot be rejected by your insurance company after 8 years. This duration acts like a moratorium period for the insurer.

Now that you are aware of what is health insurance, and its latest amendments introduced by the regulator, take advantage of these benefits to ensure comprehensive coverage for you and your family.

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