Friday, July 12, 2024

Health Insurance: Changes in health insurance



Swati Desai


Insurance companies will no longer be able to reject claims based on non-disclosure of diseases like diabetes, high blood pressure, asthma etc. No claim will be rejected after five consecutive years of premium payment. According to this, extensive changes have been made in health insurance.

The insurance regulatory body Irda made many changes in the health insurance scheme keeping in mind the interest of the policy holders. Irda has reduced the 'moratorium period' for insurance claims. At the same time, the waiting period for providing insurance cover for pre-existing disease has also been reduced. Also, the maximum age limit for purchasing the policy has also been removed. This change will benefit the policy holders.

Shortened moratorium period

The moratorium period for health insurance claims has been reduced from 8 years to five years. Now after providing cover for 60 consecutive months the insurance company cannot reject any claim of the customer on the basis of 'non-disclosure' and 'misrepresentation'. The insurance company can reject the claim only after finding fault in it.

What will be the benefit?

A claim was being rejected by an insurance company on the grounds of concealment of health information; But the company will not be able to reject the claim on this ground. Claims were being rejected for non-disclosure of diseases like diabetes, hypertension, asthma; But now no claim will be rejected after paying installments for five consecutive years.

Reduction in waiting period for 'PED'

The waiting period for insurance cover for pre-existing diseases has been reduced from four years to three years. This will soon provide insurance cover for chronic diseases like diabetes, thyroid, hypertension, asthma. In this way the policy holders will not have to wait for more than 36 months for the treatment of old diseases under the insurance. The new changes have come into effect from April 1.

As per the IRDA notification, the waiting period shall not exceed 36 months in case the pre-existing disease is diagnosed or advised for treatment by the insurance company 36 months prior to the date of issue of the policy. According to Irda, the treatment of specified diseases (except accidents) is not covered till 36 months before the health insurance comes into effect. After completion of the period these diseases, treatment will be covered by the insurance. The only condition for this is that the renewal of the policy should not have lapsed.

Easy plans should be brought

The regulatory body said insurance companies need to come up with relief schemes. According to this the policy holders will understand the information of the plans quickly. The wording of the insurance policy should be transparent and clear in terms of insurance cover and terms. The interest of the policy holders should be protected. Values ​​to be determined with respect to all risks should be appropriate.

Information about the illness has to be given to the insurance company

Irda said, while purchasing the policy, the insured has to provide the complete information about his illness to the company. On this basis the insurance company may try to reduce the waiting period and specific period of pre-existing illness in health insurance; However, this rule will not apply to policies taken out for travel abroad.

Installment should be affordable

Irda has expressed an expectation that the installment of the health insurance scheme should be affordable. Companies should ensure that premiums are affordable and cover all risks. Insurance companies should also consider withdrawing unnecessary plans, Irda said.

Maximum age requirement removed

Until now, insurance companies were obliged to provide regular health insurance to a person up to the age of 65; But now the rule has been changed and the upper age requirement has been removed. Therefore, new insurance policies will come in the market for senior citizens. Also more customized and innovative health policies will come in the market.

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