Companies will no longer be allowed to deny health insurance coverage for a broad swathe of conditions following a notification by the country’s apex insurance regulator.
The Insurance Regulatory and Development Authority of India (IRDAI) has listed a number of conditions which cannot be excluded from insurance policies if the policyholder has disclosed them beforehand. These include age-related illnesses; neurodegenerative disorders such as Alzheimer’s disease and Parkinson’s disease; congenital defects; mental health disorders; and work-related illnesses.
The notification serves to standardise exclusion policy across the health insurance sector and guarantee consistency as to what policies individuals can avail keeping in mind the pre-existing circumstances of their health. Pre-existing disease is defined by the IRDAI as any condition diagnosed 48 months or before the policy has been opened. The revised guidelines came into effect on October 1st.
Health insurance covers less than twenty percent of Indians, with 86 percent of people in rural areas and 82 percent of those in urban areas uncovered by a policy. Policyholders largely belong to the 26-45 age demographic, with women accounting for just twenty percent of policyholders. Out-of-pocket spending on healthcare, meanwhile, continues to rise – potentially indicative of a sizeable gap in the insurance market contributing in part to healthcare inaccessibility and unaffordability plaguing many Indians.
Controversies in the past have seen insurance payouts denied on the basis of certain conditions. The new guidelines could potentially avert these incidences, so long as the new regulations are properly enforced.
The standardisation of guidelines has been welcomed by some in the insurance industry. “If a person makes a proper declaration about pre-existing diseases on proposal while buying a health insurance policy, said Gurdeep Singh Batra of Bajaj Allianz General Insurance, “these guidelines provide much needed clarity to insurers in terms of which diseases can be permanently excluded and also bring in transparency as the customers will know what will be covered under the policy.”