Changes in health insurance policy guidelines from October 1, 2020

Posted on Dec, 2020
The Insurance Regulatory and Development Authority of India (IRDAI) introduced several changes to the existing Health Insurance structure in order to revamp it for making health insurance policies noticeably more customer-centric. The revamped policies came into effect from 1st October 2020, affecting all existing and new health insurance policies. For customers, this comes as great news during the ongoing coronavirus pandemic as they will be able to cover more illnesses and procedures at affordable premiums. Here is a detailed look at what the changes are and how they will affect the health insurance policies.

The Changes

When COVID struck, the IRDAI introduced a host of changes to make the health insurance policies hassle-free for COVID related claims. Looking at how well the changes were welcomed, the IRDAI, to further make health insurance policies robust has announced the following changes:

Coverage of New Illnesses:

The guidelines specify the following new illnesses to be covered under a regular health insurance policy:

  • Illnesses contracted due to any hazardous activities
  • Treatment for age-related degeneration, mental illness, artificial life maintenance and internal congenital diseases.
  • Common illnesses such as neurodevelopmental disorders, genetic disorders, menopause-related disorders etc.
  • Age-related illnesses such as hip/knee replacement surgery or cataract surgery.
  • Illnesses from the prolonged influence of harmful chemicals in factories etc.

Amended Rejection Period:

The new IRDAI guidelines states that an insurance company cannot reject a pre-existing claim if the policy has completed eight years, i.e., the policyholder has completed the payment of premium for eight straight years. Although, the insurance company can reject the insurance policy if it can prove a financial fraud or a claim for permanent exclusion on the policyholder’s part.

Standardisation of Policy clause:

The permanent concern of policyholders have always been the technical nature of health insurance plans. Not fully knowing what they are getting into, they suffer at the time of policy claim. The newly introduced standardisation would allow health insurance policies to become uniform in a way that it can be understood easily. Every important fact such as renewal, exclusions, grace period, policy cancellation etc. will have the same definition throughout the health insurance spectrum.

Telemedicine Coverage:

Popularized by the pandemic, the concept of telemedicine, where the doctors and the patients meet virtually, has also been included in the covers of health insurance policies. The newly introduced rules demand that the insurance companies must provide cover for telemedicine if the health plan covers general doctor’s consultations.

EMI Payment option:

Although entirely up to the insurance company, the new regulations suggest that the policyholders can be provided with a facility to pay the premium in equal instalments rather than a yearly lump sum amount. The insurance companies can also choose the mode and time period of EMIs as per their policy requirements.

What does it mean for the customers?

Although a lot of further amendments are still eying IRDAI’s approval, the new passed guidelines will result in more transparency in the claim process, along with making it simpler for the existing or new customers. With the standardisation of clauses, customers will be able to better compare policies and choose the most ideal one for them and their family. Extensive coverage and flexible payment options will reduce the out of pocket expenses for the policyholder, making their investment cater to their needs in the most effective way.

Health Insurance policies have always been an important investment in safeguarding a burden-free financial future. As medical expenses are always on the rise, the new changes introduced by the IRDAI will prove beneficial for the policyholders in the long run. For more information on ideal health insurance policies, you can visit PINC Insurance and start your insurance journey with our customised health insurance plans.