In a move that could bring substantial relief to patients, the Insurance Regulatory and Development Authority of India (Irdai) has told insurers that neuro development disorders, mental illness problems, psychological disorders, genetic diseases, puberty and menopause related disorders can no longer be excluded from health insurance policies.
The insurance regulator has come out with new guidelines to rationalise and standardise the exclusions in health Insurance contracts so that every insurer complies with the guidelines.
The regulator has also said that all health covers filed and cleared after April 1, 2019, have to adhere to the guidelines issued. Moreover, all existing health covers which are not in adherence with the current guidelines issued by the regulator shall not be offered and promoted April 1, 2020 onwards.
The reason the regulator has taken such a step is because, with the rise in the number of health insurers and products in the market, it will be beneficial if the industry adopts a uniform approach while incorporating exclusions in health insurance products.
Also, any expense incurred by the policyholder for any illness within 30 days from the commencement of the policy will not be covered by the health policy except for claims arising due to an accident. However, this will not be applicable for a policyholder who has continuous coverage for more than twelve months.
Moreover, the regulator has directed that no health policy can be contested after completion of eight years, which is called the moratorium period of health covers, except for cases like frauds or permanent exclusions specified in the policy contract.
The insurance regulator has said insurers have to cover patients on artificial life maintenance, including those on life support machines where there are no chances of the patient recovering and not getting back to his /her previous health condition. However, expenses shall only be covered up to the date of confirmation by the treating doctor.
The regulator has also come up with a list of diseases that health insurers were covering under their products which can be permanently excluded. The list consists of diseases like Alzheimer's, Parkinson's, malignant neoplasms, epilepsy, pancreatic diseases, chronic kidney disease, HIV and AIDS, among others.
Irdai has also said insurers can incorporate waiting periods for any specific diseases but only up to four years. However, subject to product design, insurers can also impose sub limits or annual policy limits for specific diseases in terms of amount, percentage of sum insured or number of days of hospitalisation/ treatment in the policy.
No comments:
Post a Comment