The Insurance Regulatory and Development Authority of India (IRDAI) has brought in new measures and prohibiting all health insurers from exclusion of various illnesses, while issuing health insurance contracts.
It also extended insurance coverage for all applicants who have disclosed pre-existing diseases while applying for the policy filed on or after October1, 2019. The regulator recently issued guidelines that has been made effective immediately.
“There are now clear guidelines on what can and cannot be excluded under health insurance policies,” said Subramanyam Brahmajosyula, Head (Underwriting and Reinsurance), SBI General Insurance.
Some illnesses that are not allowed from exclusion in the health insurance policies are those which are associated with hazardous activities, artificial life maintenance, mental illness, psychological, neurodegenerative, puberty, menopause, age-related macular degeneration, genetic disorders, and other such diseases.
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IRDAI has also exempted expenses incurred during the treatment of any illness, except claims arising due to an accident, within 30 days from the date of commencement of the policy.
“The regulator has standardised and simplified certain exclusion wordings so that their interpretations are simpler and uniform across the industry. The health policy would be incontestable except for fraud or any permanent exclusions. There is a moratorium of eight years,” said Shreeraj Deshpande, COO of Future Generali India Insurance.
“These guidelines also disallow ambiguous or disputable exclusions (which sometimes appear in some policies), which have been one of the major issues of discontent or dispute. However, this would have to come at a higher premium cost,” he added.
