IRDAI’s health insurance changes: Here’s how they benefit you

IRDAI revamps insurance: The Insurance Regulatory and Development Authority of India (IRDAI) has rolled out new regulations aimed at enhancing health insurance coverage and simplifying the claims process for policyholders.

Here’s a breakdown of the key measures and their implications:

Expanded coverage options

Effective immediately, IRDAI mandates that insurance companies must offer a wider array of coverage options. These include domiciliary hospitalisation, outpatient treatment, day care procedures, home care, cashless treatment, and reimbursement options.

Insurers are encouraged to develop varied products and riders to cater to different demographic needs such as senior citizens, children, and people with disabilities. This flexibility allows policyholders to choose plans that best fit their individual requirements.

Enhanced long-term security

A notable update is the new rule providing greater long-term security for policyholders. Under this rule, after continuously holding a policy for five years (60 months), insurers cannot reject claims or refuse renewal due to unintentional non-disclosure of pre-existing conditions.

This measure ensures that minor oversights during the application process will not compromise coverage after a significant period of maintaining the policy.

Faster cashless authorisation

To improve emergency care, the new regulations require insurers to process cashless authorisation requests within one hour and finalise discharge approvals within three hours.

This change aims to expedite access to treatment, reducing stress and delays during critical times.

Free-look period

IRDAI has introduced a 30-day free-look period for policyholders, starting from the receipt of the policy document. During this time, policyholders can review the policy terms and conditions.

If dissatisfied, they can cancel the policy within this period for policies with a term of one year or more, providing an opportunity to ensure the policy meets their expectations before committing fully.

Reduced waiting period for pre-existing diseases

The waiting period for coverage of pre-existing conditions and certain diseases has been capped at 36 months.

This update addresses a common concern, especially amongst senior citizens, by reducing the time policyholders must wait before these conditions are covered.

Extended grace period for premium payments

The grace period for premium payments has been extended to 15 days for monthly payments and 30 days for quarterly, half-yearly, and annual payments.

This extension ensures that policyholders have ample time to make payments without risking a lapse in coverage.

Simplified cancellation and portability

Policyholders can now cancel their insurance policies with just a seven-day notice and receive a refund for the proportionate premium of the unexpired period, provided no claims have been made.

Additionally, the process for porting policies between insurers has been streamlined, with a five-day response time for porting requests.

This includes the transfer of the sum insured, no-claim bonus, and specific waiting periods for pre-existing diseases.

These new measures by IRDAI are designed to make health insurance more accessible and user-friendly, offering policyholders enhanced protection, greater flexibility, and a smoother claims process.