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How Will Recent Amendments by IRDAI Benefit Your Health Insurance Coverage?

In this post-pandemic world, a health insurance policy is no longer optional but a must-have protection. Health being a critical factor, it is essential to have some form of safeguard if things go down south. However, with a health insurance policy, you need not worry of these unpredictable situations. The rise in various lifestyle relate ailments has further made it a necessity in present times.

Health insurance companies need to follow some prescribed guidelines. To have such regularisation, a regulatory body has been instituted, the Insurance Regulatory and Development Authority of India (IRDAI). This body governs the various plans issued by the insurance company so that you can avail streamlined treatment facilities. Here are four changes introduced and how they affect your insurance coverage. Let’s have a look:

#1 More coverage for ailments are included

This recent amendment by the regulator includes coverage for several ailments that were earlier excluded. Genetic ailments, puberty and menopause-related ailments, metal illness due to hazardous activity are now covered as per these revisions. Further, if your insurer excludes coverage for ailments like epilepsy, HIV/AIDS, then such fact needs a mention in the policy wordings. When it comes to waiting periods by the insurance companies for specific ailments, then a mention needs to be done for such duration, be it 30 days or for three years.

Such additional coverage benefits you, the policyholder, as more ailments are now covered by the different types of health insurance plans. With your health insurance policy, all these issues can be dealt without having to worry about money.

#2 Change in definition of pre-existing ailments

There is an amendment in the definition of pre-existing diseases wherein the revised guidelines clarify pre-existing diseases to be those that are diagnosed 48 months prior to the issue of your policy. The erstwhile definition created confusion which is why such a straightforward meaning was clarified.

With this positive change to remove the ambiguity that caused confusions earlier, there are lower chances of your claim getting rejected.

#3 30-day time for Settlement or Rejection of claims

This change has made it easier for policyholders since there is definite duration of 30 days for acceptance or rejection of claims. Keeping that in mind, now there will be a certainty for all claims made whether they are accepted or rejected in such 30-day period. For any delay beyond this period, the insurance company is required to pay 2% interest over the applicable bank rate as penalty on the claim amount.

All your legitimate claims will now get processed faster due to elimination of unnecessary hassles in its settlement.

#4 Claims cannot be rejected after 8 years

This new amendment clarified that if you pay the premium for 8 or more years, the insurance company is not allowed to reject the claim application. Insurance companies can no longer re-evaluate the policy once the premium is paid for such long tenure of 8 years.

A positive impact is all honest claims can no longer be rejected by the insurance company. This duration of 8 years acts a moratorium period for the insurance company.

With standardisation found across all insurance companies, it is easier to avail necessary insurance plans like critical illness insurance, family floater policy and more. Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms and conditions, please read sales brochure/policy wording carefully before concluding a sale.