In order to ensure that health insurance is convenient and consumer-oriented, the Insurance Regulatory and Development Authority of India (IRDAI) has issued new guidelines that define laws and policies about pre-existing conditions and exclusions for health insurance. These revisions will benefit the policyholders to a significant extent, as these will contribute towards making the policy coverage more comprehensive. Significant changes have been introduced in the exclusions of a health insurance policy when it comes to the meaning of pre-existing conditions and inclusions of specific illnesses.
The definition of pre-existing diseases has changed to meet the needs of customers. As per new guidelines, a disease that is diagnosed by a doctor 48 months before the issuance of a health insurance plan will now be considered as a pre-existing disease. Additionally, any disease for which a doctor recommended any medical advice 48 months before the issuance of the policy will also be considered as a pre-existing disease. In addition, any condition whose signs have resulted within three months of initiation of the policy will come in the category of a pre-existing condition.
The IRDAI has clarified that insurance providers can only include permanent exclusions after the consent of the policyholders. IRDAI’s drafting panel has issued a specified list and no further exclusions will be allowed in the insurance plan. Any health condition or illness acquired after the issuance of the policy is included in the policy. Now, some diseases that are covered in the list include AIDS/HIV, Parkinson’s disease, morbid obesity, and Alzheimer’s disease. Apart from these severe ailments, the IRDAI has released a list of guidelines, which states the ailments that are covered in the policy. Insurance companies cannot exclude ailments that are contracted because of any hazardous activity, age-related degeneration, treatment of mental illness, and artificial life maintenance. Other barred exclusions include menopause-related disorders, behavior disorders, genetic disorders, and neurodevelopment disorders. Moreover, now the insurers also need to cover knee-cap replacement and cataract surgery. Factory workers engaged in hazardous chemicals, which impact health in the long-term cannot be denied skin or respiratory ailments, which arise due to workplace conditions.
The IRDAI has standardized the exclusions for a health insurance cover. As per these guidelines, if the insurance company does not intend to cover certain ailments, it needs to use specific wordings as defined by the IRDAI in the terms of the policy. An insurer will have to specify the waiting period, which can be anywhere between one month to one year after which the cover will begin. The new norms will be applicable for covers purchased after October 1, 2019. In the case of existing health insurance policies, the new rules will be applicable from October 1, 2020.
With these regulations, the IRDAI has made it easier for individuals suffering from critical illness to get insurance.
The policyholders should also remember about the health insurance tax benefit while availing of an insurance plan. The premium paid towards the policy is eligible for a tax deduction under Section 80D of the Income Tax Act, 1961. With this strong move, the IRDAI has made insurance convenient for individuals across the country.
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