People above 65 can buy health insurance in IRDAI’s big move, check out latest rules

Health insurers have a reason to celebrate as the Insurance Regulatory and Development Authority of India (IRDAI) has made favorable changes in product regulations. These revisions will be applied to all new policies and integrated into existing policies upon renewal. In April 2024, IRDAI introduced updates to health insurance regulations, emphasizing shorter waiting periods and improved claims handling conditions for policyholders.

Also read: Affordable health insurance sees high demand, employer policies are not enough: report

The waiting time for conditions has been shortened from 8 to 5 years, while the waiting time for pre-existing conditions has also been shortened. In addition, the maximum age limit for taking out a health policy has been abolished.

Please check the details below;

Maximum age is no problem now

Until now, insurance companies had to offer regular health coverage to people up to the age of 65. Due to the change in the rules, the maximum age requirement for taking out a health policy has been abolished.

Moratorium period for claims

The moratorium period until March 31, 2024 was 8 years. Now they will be entitled to it within six years. This move is considered a huge relief as eight years is a long period and five years is enough time for pre-existing conditions to surface.

The grace period refers to the period after which an insurer can no longer refuse your claim for reasons other than fraud. This period has been reduced from 8 years to 5 years. After five years of continuous coverage (including portability and migration between policies), the insurer cannot dispute your claim on the grounds of non-disclosure or misrepresentation.

IRDAI has said that after 60 consecutive months of coverage, the insurance company cannot reject any claim of the customer on grounds of non-disclosure and misrepresentation. Only if fraud is proven can the insurer reject the claim.

Company cannot deny a claim after 5 years

Let’s understand this with an example. Suppose a policyholder pays the health insurance premium for five consecutive years, then the insurance company cannot deny the policyholder’s claim for concealing health information.

Typically, insurance companies deny claims based on failure to provide information about pre-existing conditions such as diabetes, high blood pressure and asthma, even if the reason for the policyholder’s hospitalization was for another reason. Insurance companies not only deny the claim but also cancel the policy on grounds of confidentiality.

The waiting time for pre-existing diseases is shorter

Previously, insurers could exclude coverage for pre-existing conditions for up to four years. The waiting period has now been reduced to a maximum of 3 years. This only applies to new policyholders, but existing policyholders will also benefit as their waiting period upon renewal will be reduced to match the new three-year limit.

This means that if you have a condition such as diabetes, your insurer will cover hospitalization claims related to the condition after you pay at least three premiums, as opposed to the previous requirement of four premiums.

Similarly, after 60 months of continuous coverage, insurers will no longer be able to deny claims for non-disclosure of pre-existing conditions, except in cases of proven fraud. In other words, if you have paid five annual premiums, your claim cannot be denied on the grounds of concealing your health status or providing incorrect information, unless the insurer can prove fraud.

Almost all health insurance policies have a certain waiting period for pre-existing diseases. It means that coverage for that specific disease only starts after the waiting period. So far, the rules prescribe a four-year waiting period. This has now been reduced to 3 years.

It should be noted that many insurers offer plans with a waiting period of less than 4 or 3 years. However, IRDAI’s move will help customers as the new rule now sets a reduced limit.