New IRDAI rules to make health insurance in India more efficient

  • Author :
  • TATA AIG Team
  • Published on :
  • 12/11/2020

Health insurance is a must-have for everyone as it ensures your sustained good health by bringing quality medical care within your budget.

New changes by IRDAI to make health insurance more consumer-friendly

Sadly, only about 35% of people had health insurance penetration in India as of 2018.

To encourage more people to get financial cover against medical emergencies, the Insurance Regulatory and Development Authority of India (IRDAI) has introduced several modifications. The new regulations came into effect from 1st October 2020 and brought a host of benefits for both new and existing policyholders.

If you are already subscribed to a health plan, you will notice a change in the terms and conditions as well as your coverages. If you’re planning on purchasing a new health insurance plan, read on to get an idea of the benefits on offer.

**Expanded Coverage of Health Insurance Plans **
Some of the health conditions covered by standard health insurance plans in India now include:

  • Diseases contracted due to hazardous activities
  • Mental health issues
  • Behavioural and neurodevelopment disorders
  • Age-related degenerative conditions such as Alzheimer’s and Parkinson’s
  • Cataract requiring surgery
  • Congenital diseases
  • Genetic problems
  • Puberty and menopause-related health risks

Before the amendments, the number of diseases under the permanent exclusion category was 30. As a result of the new inclusions, only 17 permanent illnesses now remain outside health coverage.

The inclusion of these conditions is especially beneficial to those policyholders who need long-term medical care.

Moreover, health insurance plans that exclude diseases must list the exclusions in the policy wordings. They must also specify the waiting period, which will lead to fewer ambiguities.

Cover for Modern Treatments
New treatments that are now included in health plans include:

  • Kneecap replacement
  • Artificial life-support
  • Oral chemotherapy
  • Robotic surgery
  • Stem cell therapy
  • Balloon sinuplasty
  • Deep brain stimulation
  • Immunotherapy with injected monoclonal antibody
  • No claim rejection for policies over eight years

If you continue paying the premium amount for eight years without breaks, insurers can no longer reject your claim. Even claims due to pre-existing health risks are valid for such long-term policyholders. However, this rule does not apply to permanent exclusions mentioned in the policy and to fraudulent claims. Moreover, insurers cannot re-evaluate policies that are over eight years old.

Clearer Definition of Pre-Existing Diseases
Any illness that was diagnosed or treated 48 months before policy issuance now falls under the classification of pre-existing disease. Moreover, if any symptoms arise within three months of the policy starting date, the illness will now be considered a pre-existing disease.

However, an insurer cannot incorporate exclusions in your policy without your consent. Also, such exclusions cannot be outside of the IRDAI-sanctioned list of health disorders. Such standardised rules will make health insurance policies more transparent.

Premium payment via EMIs
Having to pay a lump-sum premium amount could often deter you from getting health insurance. However, now you have the option of paying health insurance premiums through Equated Monthly Installments (EMIs). Therefore, buying health insurance is no longer expensive. You can find out your premium using a health insurance premium calculator and adjust your budget.

Expenses Eligible for Full Claim Settlement
You can now get your entire claim amount for pharmacy bills, implants, and diagnostics. Also, you need not bear a ratio reduction for ICU charges. Such costs now come under hospital room rent packages. However, you may see a slight decrease in the actual claim amount due to the addition of associated medical expenses.

Coverage for Telemedicine
The current pandemic and imposition of social distancing rules have led to a rise in telemedicine. Such remote consultations can be expensive. But now, if you avail of medical care through telemedicine, you can claim reimbursement from your health plan provider. So, if you have an OPD coverage policy that covers doctor consultations, you will get full claim settlement for telemedicine.

The 30-Day Period for Claim Decisions
As per the new guidelines, insurers must either settle or reject a health insurance claim within 30 days of receiving the last required document. In case the insurer does not act on the claim within 30 days, they must pay interest on the due amount. The interest rate will be 2% over the applicable bank rates.

Avail of Multiple Insurance Policies
If you have more than one medical coverage plan, you can choose to raise a claim with any of your insurers. If one insurer rejects a portion of your health insurance claim, you can apply for the balance amount from another insurer. Moreover, if you exhaust the sum insured under one policy, you can claim reimbursements for your medical expenses from your other insurance providers.

Provision for Portability
If you do not feel satisfied with your current insurance plan, you can switch to a new one. This could mean either changing your plan with the current provider or moving to a different insurer altogether. You can decide by using a health insurance premium calculator to verify if you can getter better coverage at lower prices elsewhere. However, you need to apply for migration at least 30 days before the renewal date. You can apply as early as 60 days before your policy expires.

If you have paid your health insurance premiums without any gaps, you can use the left-over amount and any benefits accrued from your previous company after migrating. You need not pay any additional premium. Any cumulative bonus awarded for claim-free years at the time of renewal of your old plan also remains intact. The waiting period from the old policy carries over as well.

Buying Health Insurance Online
You no longer need physical documents for availing of health insurance. IRDAI now allows you to complete the entire process online, from filling in the application form to issuing the policy. The insurer will then send a digital policy document to your registered email ID and/or mobile number. Your online health insurance document will be as valid as a physical copy.

The standardisation of policy wordings, waiting periods, and exclusions make policies easier to understand and have made health insurance plans in India more accessible. Further, health insurance policies have become more affordable with EMI options available for paying premiums. Budget constraints no longer have to affect your decision while buying health insurance.

So, make sure you #ThinkAhead and stay financially prepared for medical emergencies. Buy a health insurance plan from a trusted provider such as Tata AIG today!

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Disclaimer / TnC

Your policy is subjected to terms and conditions & inclusions and exclusions mentioned in your policy wording. Please go through the documents carefully.

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