Health insurance is critical to any family’s health and financial security. Health insurance provides a safety net in times of illness, ensuring you have access to necessary medical care without incurring high costs.
Whether you are an existing health insurance policy holder or planning to buy a new one, it is essential to learn the latest change in health insurance regulations effective under health insurance new rules as the IRDAI (Insurance Regulatory and Development Authority of India) made a big move.
Table of Contents
List of 11 Health Insurance New Rules by IRDAI in 2024
1. Health Insurance policy – Entry Age Limit Removed
As per IRDAI health insurance new rules, the entry age restriction has been removed. Earlier, most insurance companies had health insurance buying/entry age of at least up to 65 years. This update is especially beneficial for senior citizens, allowing them the flexibility to obtain comprehensive medical policy as needed.
2. Pre-existing Disease (PED) Waiting Period Reduced to 3 years
As per IRDAI health insurance new rules, the pre-existing disease waiting period is reduced from 4 to 3 years for new and existing policies upon renewal; this will empower policyholders to claim the treatment cost of pre-existing diseases after serving a maximum waiting period of 3 years.
3. The moratorium period was reduced from 8 to 5 years
The monitoring period is a duration after which insurance cannot deny your claim (including portability and migration between policies) for reasons other than fraud; this means the insurance company cannot reject a genuine health insurance claim after the policy has completed 5 years (combining portability and migration) on the ground of non-disclosure of pre-existing diseases or misinterpretation.
Example: You bought a medical policy from ABZ Insurance Company on 1st Jan 2022, and after continuing for two years, you decided to port the policy from ABC Insurance Company to XYZ Company on 1st Jan 2024. In this case, your moratorium period completion will be considered on 1st Jan 2025.
4. Grace Period for payment of premium
As per IRDAI health insurance new rules, the grace period to pay the premium has been standardized based on the frequency of premium payment.
- (a) The grace period of fifteen days; where the premium is paid monthly.
- (b) The grace period of thirty days, where the premium is paid in quarterly/half-yearly/annual instalments.
5. Availability of insurance coverage during the grace period
As per IRDAI health insurance new rules, coverage will also be available for the grace period. Earlier, if the policy premium was paid during the grace period, the ball was in the health insurance company’s court to decide if they would settle the claim.
6. Approval for Cashless facility
As per IRDAI health insurance new rules, every insurance company shall strive to achieve 100% cashless claim settlement in a time-bound manner. The insurance company shall decide on the request for cashless authorization immediately but not more than one hour after receipt of the request. The Insurer shall put necessary systems and procedures in place immediately or before 31st July 2024.
7. Final authorization for Discharge from the hospital
The Insurer shall grant final approval within three hours of receiving the discharge authorization request from the hospital. In no case shall the policyholder be made to wait to be discharged from the hospital.
8. Free Look Period
Policyholders are granted a 30-day window (beginning from receipt of the policy document) to examine their policy’s terms and conditions carefully. If they find any aspect unsatisfactory, they can cancel their policy. This provision applies to policies with a duration of 1 year or longer.
9. Claims under multiple policies held by policyholders
The IRDA health insurance new rules allow policyholders with benefit-based policies to file various claims with several insurers.
10. Issue Policies to People with Severe Medical Conditions
The insurance regulator has also prohibited health insurance companies from refusing health policies to people with pre-existing diseases and chronic conditions.
11. No Sub-Limits on AYUSH Treatment
IRDAI has removed sub-limits on AYUSH treatments; this ensures Ayush treatments are at par with the other treatments to provide the option to the policyholders to choose the treatment of their choice.
Source: master circular on health insurance
Conclusion
It is important to stay updated with the latest policy changes; these recent changes are introduced to protect policyholders’ interests.
However, in this busy world, if you find it difficult to keep a tap of every update and, due to overwhelming information, are unable to take action, then you must consider financial planning to take a structured approach to your personal finance management.
