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Know How New Proposals on Health Insurance Can Change Your Life

The new proposals suggested by the IRDAI-constituted panel is aimed at making health insurance more transparent and customer-friendly.

  • 01 Dec 2018
  • min read

An effective risk mitigating tool that prevents out-of-pocket expenses during a medical emergency, health insurance  is a modern-day need. A growing segment, the standalone health insurance market in India is expected to grow at a CAGR of 30% in the next five years and will be worth Rs. 21,904 crore by 2022.

In what could further make health insurance more customer-friendly, transparent and boost the growth of the sector, a working panel constituted by insurance regulator IRDAI has proposed several changes. Read on to know the effects of these changes on your health insurance policy.

Clearer Definition of Pre-Existing Diseases

A major bone of contention in a health insurance policy is the interpretation of pre-existing diseases. The working panel has suggested a simpler and clearer definition of pre-existing diseases to weed out any anomaly over its interpretation and subsequent disputes.

According to the suggested definition, any disease, injury, condition or ailment diagnosed prior to buying the first policy for which medical treatment or advise was recommended or received from a doctor qualifies as a pre-existing disease.

With a simpler definition, as a policyholder, you would know about the conditions or ailments that qualify as a pre-existing disease which you need to disclose while filling up the proposal form to avoid rejection. The working panel has also asked insurers to take a lenient view in case a pre-existing disease is discovered later.

Insurers have been recommended by the working panel to put a waiting period on such diseases, instead of cancelling the policy. The option, however, will be available only during the moratorium period.

Lowering Waiting Period of Lifestyle Diseases

Lifestyle diseases have evolved as one of the biggest killers in India. As per studies conducted by the Indian Council of Medical Research (ICMR) and other institutes, estimated proportion of all deaths from lifestyle styles has gone up from 37.09% in 1990 to 61.8% in 2016. The high-treatment cost of lifestyle diseases can derail a family’s finances.

On most occasions, the waiting period of lifestyle diseases such as diabetes, hypertension and cardiac problems range from one to four years. Waiting period refers to the time/duration during which you can’t make a claim from your Mediclaim insurance.

However, the working panel has suggested lowering the waiting period of lifestyle diseases up to 30 days (maximum), unless they are pre-existing.

Standardisation of Pre-Existing Diseases

The working panel has also proposed a standard list of 17 pre-existing diseases which could be excluded from a Mediclaim policy. The list includes diseases such as epilepsy, cerebral stroke, chronic heart and kidney diseases, HIV, AIDS, Parkinson’s, hepatitis B, loss of hearing and other physical disabilities.

It has also said that policyholders can’t be denied coverage for AIDS, Parkinson’s, Alzheimer’s and morbid obesity if diagnosed after the purchase of a policy.

This means if you contact the above-mentioned diseases after buying a health insurance policy, you will be entitled to receive coverage for them. To put it simply, the working panel has suggested all health conditions acquired after policy issuance to be covered. Experts believe that this standardisation will help in the smooth settlement of claims.

Easy Coverage for Individuals with Severe Health Conditions

People with severe health conditions such as epilepsy and physical disabilities find it difficult to avail a health insurance policy. Also, insurers are wary about extending cover to cancer survivors. They are usually denied coverage for procedures and diseases that may be completely unrelated.

If the proposals of the panel are accepted, it’ll become easy for such individuals to avail health insurance. However, no coverage will be provided for specific pre-existing diseases. Nevertheless, if you are suffering from a severe health condition and are denied a Mediclaim insurance, the road ahead might be a little easy for you.

Claims Can’t be Questioned After Eight Years of Continuous Renewals

Another proposal mooted by the panel is that insurers can’t question claims on basis of non-disclosure after eight years of continuous renewals, except in cases of frauds. It means if you’ve renewed your policy for straight years since its inception, the insurer can’t raise objections on your claims on grounds of concealing information.

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This will ease your worries and concerns regarding claim rejection if you have paid all the premiums on time. However, it’s essential to note that the co-pay, sub-limit and all the other applicable clauses as mentioned in the policy document will remain in force.

Coverage for Advanced Treatment Procedures

The panel has also proposed setting up of a Health Assessment Technology Committee that will recommend inclusion of advanced and modern treatment procedures for which you will be offered coverage. Insurers will have to provide coverage for procedures listed by the committee.

The above proposals are set to be reviewed and expected to be implemented in the next year. If accepted and applied, these will help you make the most out of your health insurance policy.

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