To widen access to healthcare coverage, the Insurance Regulatory and Development Authority of India (Irdai) has removed the age cap of 65 years for individuals purchasing health insurance policies.
Effective from April 1, 2024, any individual, regardless of age, can purchase a health insurance policy. The move is aimed at enhancing the market penetration for insurance products, while also providing protection against healthcare expenses to all demographics.
Irdai said in a notification on March 24, 2024: “Insurers shall ensure that they offer health insurance products to cater to all age groups. Insurers may design products specifically for senior citizens, students, children, maternity, and any other group, as specified by the competent authority.”
Insurers and industry experts have welcomed the move.
Siddharth Singhal, business head – health insurance, Policybazaar.com said: “The removal of the age cap on health insurance policies by the regulator marks a significant step towards ensuring equitable access to healthcare for senior citizens. This move offers elderly policyholders the opportunity to avail of comprehensive health insurance coverage without being restricted by age-based limitations.”
“Senior citizens should inquire about waiting periods when purchasing a policy and understand how it may affect coverage for pre-existing conditions. Moreover, senior citizens should be aware of the coverage features and exclusions of health insurance policies they intend to purchase. It’s essential to carefully review policy documents, including any cappings, such as room rent capping, co-payment requirements, and sub-limits on specific treatments. They must clarify any doubts with the insurer to ensure that there is no discrepancy and they fully understand the terms and conditions of their policy,” Singhal added.
The maximum waiting period for pre-existing diseases has been reduced from four years to three years, which means insurers are now prohibited from rejecting claims if one has paid premiums for three years.
After 60 months of continuous coverage of the policy, except in cases of proven fraud, insurers cannot reject the claim citing non-disclosure of pre-existing diseases (PEDs). For instance, even if one is suffering from diabetes, hypertension or any other PED, insurers must pay for the treatment even if one has not disclosed them, provided the insured was continuously covered for 60 months.
“After completion of 60 continuous months of coverage (including portability and migration) in health insurance policy, no policy and claim shall be contestable by the insurer on grounds of non-disclosure, misrepresentation, except on grounds of established fraud. This period of 60 continuous months is called as moratorium period,” the notification said.
Further, insurers should leave avenues open for individuals with pre-existing medical conditions, such as cancer, heart or kidney failure, and AIDS to be covered, and should not deny coverage to them.
Additionally, they should offer options for premium payment in multiple instalments for policyholders’ convenience.
Irdai further stipulates that travel policies can only be offered by general and health insurers. Additionally, insurers shall have a board-approved policy for providing AYUSH coverage, which inter-alia, should include their approach towards placing AYUSH treatments at par with other treatments for health insurance to provide an option to the policyholder to choose a treatment of their choice, Irdai said.
