New Health Insurance rules by IRDAI – April 2024
In April 2024, the insurance regulator IRDAI introduced changes to the health insurance regulations to protect policyholders and improve the health insurance experience.
These revisions will be applied toall new policies and integrated into existing policies upon renewal.
These changes are as follows:
- Reduced moratorium period for claims
The moratorium period is the duration after which the insurer cannot deny a policyholder’s claim for reasons other than fraud. This period has been reduced from 8 years to 5 years.
The IRDAI has stated that following 60 months of continuous coverage, an insurer cannot deny a claim unless it can prove that the claim is fraudulent. This also applies in the case of pre-existing diseases (PEDs)!
The insurer cannot reject the claim even on the grounds of non-disclosure and misrepresentation.
- Reduced waiting period for pre-existing diseases (PEDs)
Pre-existing diseases (PED) or conditions are illnesses or diseases that the policyholder may already be suffering from at the time of taking the policy. These PEDs are usually excluded by the insurer for the first 4 years of the policy.
The IRDAI has now directed insurers to reduce this from 4 years to 3 years.
While there are insurers which offer lower waiting periods than 3 years to certain customers depending on their underwriting guidelines, this new rule will ensure that the waiting period is no more than 3 years.
- No more maximum age to avail health insurance
Until March 2024, an individual above 65 years of age could not avail health insurance as this was the maximum limit set by insurers. With the new IRDAI rule, insurers have been directed to remove this limit and introduce targeted policies for senior citizens to address the lack of health insurance and grievances of senior citizens.
The IRDAI stated “Insurers shall ensure that they offer health insurance products to cater to all the age groups. Insurers may design products specifically for senior citizens, students, children, maternity and any other group as specified by the Competent Authority.”
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