Health Insurance

Looking at 5 Important Changes the Health Insurance Sector Has Seen in 2020

In recent times, we have seen many changes issued by the Insurance and Regulatory Development Authority of India (IRDAI) on health insurance in the country.  From an increase in the number of illnesses covered to the standardization of policy wordings, these changes seem to be an attempt to make health insurance more policyholder-friendly. And, that is definitely great news for the masses. 

In this article, we are looking at five such major changes and the impact they are likely to have on the policyholder. 

#1 – Option to pay the premiums in instalments 

In a landmark move, IRDAI has allowed the policyholder to pay their yearly health insurance premium on a monthly, quarterly, or half-yearly basis. So, if your yearly premium is Rs 15,000, you can pay quarterly instalments of Rs 5000 each. This will considerably reduce the pressure that paying a large premium at once could bring, especially for senior citizens for whom policy premiums often go high. 

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#2 – Increase in the number of illnesses covered

According to IRDAI guidelines, several illnesses that were formerly excluded under health insurance policies will be given coverage now. Going forward, you can expect health insurance policies to cover the following- 

– Mental illnesses 

– Genetic diseases 

– Psychological and neurodegenerative disorders

– Disorders related to puberty and menopause

– Disorders related to behaviour and neurodevelopment

– Age-related degeneration 

The inclusion of these illnesses is likely to bring a positive impact as it will increase awareness and accessibility of good healthcare in India.  

#3 – Standardization of the definition of pre-existing diseases 

IRDAI has standardized the definition of pre-existing diseases or PEDs as any illnesses or diseases that have been diagnosed by a doctor 48 months prior to the time the insured individual has been issued the policy. This also extends to any kind of medical treatment prescribed by a physician to the individual in the aforementioned period. Additionally, if a particular illness shows symptoms and signs within 3 months of taking the health insurance policy, then that too will be considered a pre-existing disease given the policyholder informs the insurance provider about the same. 

#4 – No ambiguity in policy wordings 

Often, health insurance policies have wordings that may confuse the policyholder, leading to problems during claim settlements. To avoid this in the future, IRDAI has now issued standardized wordings for several terms and clauses relating to exclusions within policies. All insurance providers are expected to use the standardized policy wordings henceforth. For someone looking to buy health insurance, this can be very helpful as it eases up the comparison process while purchasing insurance. 

5. No rejection of claim after 8 years of policy 

If the policyholder has been paying premiums consistently for 8 years, then the health insurance company will have to settle all claims made by the policyholder beginning from the 9th year of the policy. This excludes proven fraud and permanent exclusions and is subject to the sub-limits, deductibles, and terms and conditions of the policy. Honest policyholders can take a deep breath as their genuine claims are more likely to be settled now. 

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We hope this article has helped enlighten you about some key changes in health insurance that have taken place this year. 

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