October 15, 2019
Insurance companies have been barred from excluding from coverage illnesses associated with hazardous work activity, artificial life maintenance, treatment of mental illness, age-related degeneration and internal congenital diseases. The IRDAI said that age-related ailments such as cataract surgery, kneecap replacements, Alzheimer’s and Parkinson’s disease would also have to be covered
The regulator has also standardised exclusions—which means if an insurer does not want to cover epilepsy, chronic kidney diseases and HIV/AIDS—there are specific wordings to be used and a specific waiting period (30 days-1 year) after which coverage would begin.
Standardisation of health regulations will also help portability. IRDAI said, “If a person transfers from one insurer to the other — and has already completed in part some of the waiting period requirement — then the new insurer may impose only the unexpired/residual waiting period not exceeding 48 months from the date of first issuance of the policy.”
The IRDAI also said,“Every health insurance product shall cover all pre-existing diseases disclosed by the persons to be insured immediately after the expiry of the 48 months waiting period or such lower period as stipulated in the product.”
However, TPAs and brokers warn that while these moves by the IRDAI are pro-customer, they could affect pricing.