The Insurance Regulatory and Development Authority of India (Irdai) introduced various health insurance regulations that brought in many developments in the health insurance industry. Here are some of the key changes in the health insurance industry in India in 2019.
Guidelines for a standard product
In February this year, Irdai issued draft guidelines for a vanilla standard health insurance product common to all non-life insurance companies – both general and health. The standard health product will cover both pre- and post-hospitalisation expenses and the consumers will also have the option of taking treatment under AYUSH scheme, subject to sub-limits. While the minimum sum insured in the standard policy will be Rs 50,000, the maximum limit will be `10 lakh. Insurers are allowed to follow differential pricing and charge a lower premium from an old customer against a new customer regardless of their age. The proposed plan will remain a basic insurance product and customers will not be allowed any add-ons or riders.
Standardisation of exclusions
Irdai issued guidelines for standardisation or pre-defined format for the exclusions in a standard health insurance policy. A list of exclusions will be prepared and moving forward, only the listed ailments will be excluded from the health insurance policy. This means that now health insurance policy will be an all-inclusive product covering you for all possible health risks. Age-related ailments like knee-cap replacements, mental illness, cataract surgery, Alzheimer’s and Parkinson’s, etc., which were earlier excluded will now be covered by the insurance company.
As per the guidelines, any disease/s or ailment/s that is/are diagnosed by a physician 48 months prior to the issuance of the health cover will now be classified under pre-existing disease. Moreover, any disease/s or ailment/s for which any type of medical advice or treatment was recommended by a qualified doctor 48 months prior to the issuance of the policy will also qualify under pre-existing diseases (PED). Any other condition whose symptoms or signs have resulted in a serious disease within three months of the issuance of the policy will also be classified under PED.
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With the aim of making mental healthcare available to all, Irdai has made it mandatory to include mental illnesses and several other health issues in all regular health insurance coverage. In the exposure draft, Irdai made it clear that insurers cannot deny coverage to policyholders who have used opioids or anti-depressants in the past. Insurers can’t deny coverage to people with a history of clinical depression, personality or neurodegenerative disorders, sociopathy and psychopathy.
Ability to choose TPA
The regulator has allowed policyholders to choose third-party administrator (TPA) at the time of buying a health insurance policy or at the time of renewal, thus providing more flexibility and encouraging the entire health insurance ecosystem to constantly ensure that customers get the best service experience.Source: The Financial Express