IRDAI eliminates health insurance age limit, implements major changes in pre-existing disease policies

New Delhi: The Insurance Regulatory and Development Authority of India (IRDAI) has made significant changes to health insurance regulations, including the elimination of the age limit for purchasing health insurance plans. This decision, set to take effect on April 1, 2024, marks a major shift in the industry.

Previously, individuals aged 65 and older were restricted from purchasing new health insurance coverage. However, the recent regulatory changes now allow individuals of any age to access new health insurance coverage.

In a notice issued by IRDAI, insurers are encouraged to expand their services to cater to various demographic groups, such as senior citizens, students, children, and maternity needs. The aim is to promote inclusivity in healthcare coverage by offering individualized plans that meet specific age-related requirements.

The decision reflects IRDAI’s commitment to improving the availability of affordable healthcare coverage across all age groups and enhancing accessibility to such coverage. By removing age restrictions, IRDAI hopes to stimulate innovation among insurance companies, leading to a wider range of product offerings and improved customer service.

Additionally, IRDAI mandates that health insurance carriers develop customized plans for older individuals, including dedicated channels for managing claims and complaints from senior citizens. This proactive approach aims to address the unique healthcare needs of elderly policyholders.

Industry professionals have welcomed the potential of this regulatory reform to extend healthcare coverage to individuals over the age of 65. With established underwriting procedures, insurance companies can now offer coverage to senior citizens based on affordability and viability criteria.

Another significant reform prohibits insurance companies from denying coverage to individuals with severe medical conditions such as cancer, heart or renal failure, or AIDS. The waiting period for coverage of pre-existing conditions has also been reduced from forty-eight months to thirty-six months. After this period, all pre-existing conditions must be covered, regardless of initial disclosure.

Furthermore, IRDAI has mandated a transition from indemnity-based health policies, which reimburse hospital bills, to benefit-based policies, which provide predetermined payments upon the diagnosis of covered illnesses. This change aims to enhance the clarity and predictability of insurance products, ensuring that policyholders receive timely and transparent benefits.

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