The growing number of lifestyle diseases, double-digit medical inflation, rising healthcare costs and increasing uncertainties are slowly but surely making Indians realize the immense value of a health insurance policy. Undoubtedly, the mindset is changing. However, as the spotlight intensifies, is it appropriate to claim that our health insurance sector and policies are flawless with no room for improvement?
Most experts would say “No, it is not.”
IRDAI, Insurance Regulatory and Development Authority of India, paying attention to evolving health insurance needs across the country, has introduced some changes. These updates are aimed at making your medical insurance more standardised, easy to interpret or understand and customer-friendly.
All existing healthcare insurance plans have to adapt to these developments by October’2020. The new plans launched since October’2019 must implement them with immediate effect.
1] Definition of Pre-existing Diseases
- The earlier definition included illnesses diagnosed within three months after the purchase of the policy.
- Now, the definition has been changed.
- “The additional/modified clause” has been deleted.
- No such disease will be treated as the pre-existing one even if it gets diagnosed within three months (or later) of buying insurance.
- It could lead to a reduction in the claim rejection rates.
2] Inclusion of Critical Illnesses
- IRDAI is considering revisiting the exclusion of critical illnesses in health insurance.
- Psychological, neurodegenerative or neuro-development disorders and mental or genetic diseases will be covered in your policy.
3] Minimum-Maximum Sum Insured Limit
- Your policy’s minimum and the maximum sum insured limit has been revised to 1 lakh (minimum) and 5 lakh rupees (maximum).
4] Waiting Period
- The waiting period for many diseases has been updated.
- Twenty-four months (such as pilonidal sinus and cysts).
- Forty-eight months (including joint-replacement treatment, if not due to age or any accident).
5] A Revised Exclusion List
- IRDAI has updated the list.
- Now, 16 diseases (including chronic kidney problems and epilepsy) will no longer be covered by insurance companies.
6] Premium Payment In Instalments
- No need to pay the health insurance premium in one go and adversely impact your monthly budget.
- Policyholders can now pay it in monthly, quarterly and half-yearly instalments.
- The monthly and quarterly premiums free look period will be less than what you get in case of annual premium payment.
7] Grace Period for Premium Payment
- Customers to get few days for premium payment in case they do not meet the policy period deadline.
- The grace period could vary from 15 days (other payment modes) to 30 days (yearly payment mode).
8] Claim Denial Process
- Every insurance company must follow the exclusion basis and 18 codes as provided by IRDAI to deny any claim.
- Insurers will not be able to offer fake reasons while denying claims.
9] Lifelong Renewability
- As per earlier guidelines, the maximum age limit to be a part of any health insurance policy was 65 years.
- Now, the insurers can increase the maximum age limit and inform the regulator on a certification basis about the change.
- They may also decrease the minimum age for insurance policies.
10] Timeline for Checking & Canceling the Policy
- You get 15 days (from the purchase date) to check all the terms, conditions and cancel the insurance policy.
Insurance companies should also present a list of TPAs at the time of selling policies so that buyers can pick a TPA of their choice.
As a result of product modifications, medical insurance companies will be allowed to increase and decrease premiums by 15% depending on the loss-ratio numbers of the last three financial years. Any such increase shall be only after three years from the launch of the approved individual product.
The Indian healthcare insurance sector is miles away from being perfect. All major insurers are continually trying to improve their products or services by adopting innovative and cutting edge technologies. At the same time, many positive changes from IRDAI are certainly in favour of policyholders.
Health insurance is seen as an indispensable part of our lives. A timely medical policy always comes in handy and secures you against a variety of undesired circumstances.
Do not wait! At Quickinsure, compare health insurance plans and policies by going through quotes from various established insurance providers.
Sources: IRDAI, The Economic Times, Financial Express, Live Mint, Money Control, Deccan, Wikipedia and other information channels.