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New IRDAI Health Insurance Guidelines for Senior Citizens!

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In a move to broaden the market and ensure comprehensive coverage against healthcare costs, the insurance regulator IRDAI has eliminated the age restriction of 65 years for individuals purchasing health insurance policies. This represents a noteworthy departure from previous regulations that restricted people from obtaining full coverage.

By removing the maximum age limit for purchasing health insurance plans, the Insurance Regulatory and Development Authority of India (IRDAI) seeks to cultivate a more inclusive and accessible healthcare environment, guaranteeing sufficient protection against unexpected medical costs.

Under the previous guidelines, individuals could only purchase a new insurance policy until reaching the age of 65. However, effective from April 1, a recent amendment has made it possible for anyone, regardless of age, to be eligible to purchase a new health insurance policy.

In a recent gazette notification, IRDAI said, “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.”

While there was no explicit prohibition on selling policies to individuals above 65, only a handful of insurers offered health policies to first-time buyers in that age bracket.

Breaking down the new guidelines

Under the previous Health Insurance Regulations of 2016, IRDAI mandated insurers to extend policy offerings to individuals at least up to the age of 65 years. “All health insurance policies shall ordinarily provide for an entry age of at least up to 65 years,” it stipulated. Consequently, the insurance companies were required to entertain proposals from those up to this age threshold. However, there was never a prohibition on selling health insurance policies to those beyond the age of 65.

In practice, the recent regulatory adjustment doesn’t alter the ability of senior citizens to purchase insurance. Even before the change, they could acquire insurance products regardless of being above the age of 65, albeit with limited options in the market. Now, with the age limit removed, there’s potential for more insurance companies to introduce specialized products tailored for senior citizens.

Certainly, it’s important to note that despite the regulatory changes, insurers aren’t obligated to provide health insurance policies to senior citizens or those above 65. The decision remains at the discretion of each insurance company, based on their business strategy and willingness to serve this demographic.

Additional changes

Following the recent notification, the insurers are now also barred from rejecting policy issuance to individuals with severe medical conditions such as cancer, heart or renal failure, and AIDS.

Under the revised guidelines, the waiting periods for covering pre-existing diseases have been reduced, now capped at a maximum of three years, down from the previous four years.

As per the notification, IRDAI has reduced the health insurance waiting period from 48 months to 36 months. The insurance regulator mandates that all pre-existing conditions should be covered after 36 months, regardless of whether the policyholder disclosed them initially or not. In essence, health insurers are prohibited from rejecting claims based on pre-existing conditions after these 36 months.

The IRDAI has additionally reduced the maximum waiting period for specific diseases/procedures, such as joint replacement surgery, under health plans from 4 years to 3 years. This adjustment allows individuals to file health insurance claims for listed diseases/procedures after waiting for a maximum of 3 years.

The IRDAI has eliminated sub-limits on AYUSH treatments. Under this guideline, policyholders will be able to claim the cost of treatments obtained through Ayurveda, Yoga, Naturopathy, Siddha, Unani, and Homeopathy systems of medicine up to the sum insured limit.

The IRDAI has also directed insurers to establish a specialized channel dedicated to handling the claims and complaints of senior citizens. This initiative aims to ensure a more responsive and tailored approach to meet the needs and address the concerns of senior citizens effectively.

Smooth access to quality healthcare

These policy changes will facilitate smooth access to quality healthcare for senior citizens. Moreover, when selecting the appropriate coverage that suits their needs, consumers should consider factors such as the insurer’s cashless network of healthcare providers, room rent limit, benefits, sub-limits, and other policy terms and conditions. This thorough evaluation will enable individuals to obtain coverage that aligns perfectly with their requirements and budget.

Summing up

India currently has a predominantly young population; however, the proportion of individuals above the age of 60 is projected to increase to 20% by 2050. Despite this demographic shift, insurance companies currently do not offer many policies tailored specifically for senior citizens.

Experts and industry insiders anticipate that most insurers will develop health insurance policies specifically designed for senior citizens, unlike the standard health covers usually available to those under 60 years of age. However, these specialized policies are expected to come with significantly higher costs compared to the standard covers currently offered by insurance companies.