Insurance Regulator Do Away With Age Cap On Health Insurance: 10 Points

In a significant move towards promoting inclusivity in healthcare, insurance regulator Insurance Regulatory and Development Authority of India (IRDAI) has removed the age limitation to buy health insurance, effective from April 1, 2024. According to an expert, the move will now open avenues for people above 65 to seek health cover, and the coverage is subject to offer and acceptance between the Insured and Insurer based on affordability for senior citizens and viability for Insurers.

Here are 10 key points regarding this development:

1. Previously, individuals were restricted from purchasing new health insurance policies beyond the age of 65. However, with the recent withdrawal by IRDAI, individuals can now buy new health insurance plans at any age.
2. IRDAI”s decision aims to create a more inclusive healthcare ecosystem in India, ensuring that individuals, regardless of age, have access to health insurance coverage.
3. Insurance providers are directed to offer health insurance products catering to various age groups, including senior citizens, students, children, maternity, and other demographics as specified by the Competent Authority.
4. Insurers are mandated to establish dedicated channels for handling claims and grievances of specific demographic groups, such as senior citizens, ensuring efficient and personalized service.
5. Insurers can cover individuals above 65 based on their Board-approved Underwriting guidelines, subject to affordability for senior citizens and viability for insurers.
6. Insurers are prohibited from refusing to issue policies to individuals with severe medical conditions like cancer, heart or renal failure, and AIDS.
7. IRDAI has reduced the health insurance waiting period from 48 months to 36 months. Pre-existing conditions should be covered after 36 months, regardless of initial disclosure.
8. Health insurers are barred from rejecting claims based on pre-existing conditions after the specified waiting period of 36 months, providing greater security to policyholders.
9. Insurance companies are directed to offer benefit-based policies instead of indemnity-based policies, ensuring fixed costs upon the occurrence of covered diseases.
10. These regulatory changes by IRDAI aim to enhance consumer protection, streamline insurance processes, and foster greater transparency in the health insurance sector, benefiting individuals seeking comprehensive coverage across all age groups.