In order to make health insurance accessible to all, the Insurance Regulatory & Development Authority of India (IRDAI) recently included some new laws in order to make health insurance more user-friendly.

To start with, a committee report that limits exclusions under a health insurance policy has been introduced which are completely customer-friendly. Especially, IRDAI issued a draft to introduce a standard health insurance plan for all with a basic sum insured of ₹50,000 to ₹10 lakh, as per the necessity of the customer.

18 years will be the minimum age of entry for buying the policy & 65 years will be the maximum age. The plan will be indemnity-based with lifelong renewability option.

Alternative medicine
IRDAI also mandated that the standard health insurance plan will also provide coverage for expenses incurred on alternative treatment such as AYUSH, which includes homeopathy, ayurveda, siddha or unani. The expenses, though, will completely be subject to fixed & standard sub-limits on the sum insured.

Another major proposal submitted is a four-year waiting period for inclusion of any ailment in the health cover against the current waiting period which is for two years. However, for some conditions such as hypertension, diabetes & cardiac problems, the waiting period must be reduced to 30 days. Moreover, in order to ensure that the people suffering from pre-existing diseases, including those with disabilities, get proper health insurance, the insurers will include permanent exclusions with due consent of the customer.

Also, insurers wont be entitled to question the claims of the policyholder on the ground of non-disclosure. However, this will only be applicable after 8 years of continuous renewals by the policyholder. However, the policy would be entirely subject to all clauses, including sub-limits, co-pay & deductibles as mentioned in the policy contract.

Mental health
With the aim of making mental healthcare available to all, IRDAI has directed insurers to include mental illnesses to be included in all regular health insurance policies. IRDAI made it quite clear that insurers cannot deny coverage to policyholders who have used opioids or anti-depressants in the past. Also, insurers can't refuse coverage to people with a proven history of clinical depression, personality or neurodegenerative disorders, sociopathy & psychopathy.

It was often noted that a certain group of patients including cancer survivors, epilepsy patients & many others with specific permanent physical disabilities are denied medical coverage due to their severe health conditions.

Further, all health conditions & illnesses acquired after the issuance of policy, apart from those not covered under the policy contract (like infertility & maternity), will now be covered under the policy. Various major ailments are there that can't be permanently excluded.

Alzheimer, Parkinsons, AIDS/HIV & morbid obesity are some of the important & major diseases that must be added to the list.

It's a good chance to review your insurance portfolio, with all these changes in place & make sure that all health-related risks are covered by the insurer.

by Amit Chhabra

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