This year, IRDAI has brought important updates to health insurance and term insurance policies in India. These changes aim to give better protection and make insurance more consumer-friendly. The new rules focus on areas like waiting periods for pre-existing diseases, premium stability, cashless claims, surrender value and more. Here is a simple breakdown of the new IRDAI health insurance guidelines for 2025.
List of new health insurance guidelines by IRDAI
Here’s a detailed look at the key health insurance guidelines introduced by IRDAI in 2025, aimed at improving accessibility, affordability and transparency for all policyholders:
1. Health insurance plans for all age groups
According to the IRDA regulations for health insurance, companies can no longer set an upper age limit for new policies. Earlier, most policies were not available to people above 65 years. Now, at least one policy must be offered to every applicant, regardless of age. This change helps elderly people get health insurance at any stage of life.
2. Pre-existing disease waiting period reduction
The waiting period has been reduced for pre-existing diseases. Earlier, policyholders had to wait up to four years for coverage of such diseases. Now, as per the latest IRDAI health insurance regulations, the maximum waiting period is three years. After this period, insurance companies must cover pre-existing diseases. This makes it easier for people with health issues to get treatment without a long wait
3. Cashless claim settlement
Insurers must now have a network of hospitals that support cashless claim payments. IRDAI guidelines on health insurance state that policyholders can get treatment at these hospitals without paying from their pocket first. The insurer pays the hospital directly. This reduces financial stress during emergencies and makes the claim process smoother
4. The moratorium period has been reduced
The moratorium period has been reduced to five years under the IRDAI's new guidelines for health insurance. Earlier, this period was eight years. After five years of continuous coverage, insurers can't deny claims because of non-disclosure of pre-existing conditions, except in cases of fraud. This rule applies to both porting (changing insurers) and migration (changing plans within the same insurer). Policyholders get more confidence that their claims will not be rejected after this period.
5. Ayush coverage
AYUSH treatments (Ayurveda, Yoga, Naturopathy, Unani, Siddha, Homoeopathy) are now covered up to the full sum insured. There are no sub-limits on AYUSH expenses. The range of treatments remains the same, but now policyholders can claim the full amount for these treatments. This encourages holistic healthcare and gives policyholders more choices.
6. Customised plans for specialised groups
Insurers must offer customised health insurance plans for different groups, including senior citizens, children, students and maternity cases. Specialised plans help people choose coverage that fits their unique needs.
7. Specific disease waiting period adjustment
The waiting period for specific diseases and procedures, like joint replacement, has also been reduced from 4 years to 3 years. This means policyholders can claim for these conditions sooner than they could before.
8. Inclusivity for severe medical conditions
Insurers cannot deny health insurance to people with severe pre-existing conditions like cancer, heart disease or AIDS. These health insurance IRDA guidelines are more inclusive and ensure that people with serious illnesses can get coverage.
9.Model products for vulnerable groups
IRDAI has asked insurers to design model products for vulnerable groups. These include senior citizens, people with disabilities and those with critical illnesses. The primary purpose of these model products is to make health insurance accessible to every citizen.
10. Allowance for multiple claims across insurers
Policyholders can now file multiple claims with different insurers if they have more than one policy. This gives more flexibility and ensures wider coverage for policyholders.
Conclusion
The IRDAI's new guidelines for health insurance make medical services more accessible and fair for everyone. There are no age limits, waiting periods have become shorter and claim processes are now faster. AYUSH treatments will now get full coverage, and people with severe illnesses are no longer left out. These changes help more people get the protection they need and build trust in the insurance system.
FAQs
- Who can buy health insurance now?
Regardless of their age, caste or creed, anyone can now buy health insurance.
- What is the new waiting period for pre-existing diseases?
The waiting period is now a maximum of three years.
- Can I get cashless treatment?
Yes, you can get cashless treatment at network hospitals.
- Are AYUSH treatments fully covered?
Yes, AYUSH treatments are covered up to the full sum insured.
- Can people with serious diseases get insurance?
Yes, insurers cannot deny coverage to people with severe conditions.
Disclaimer: The information provided in this blog is for educational and informational purposes only. It is not intended as a substitute for professional advice, diagnosis or treatment. Please consult a certified medical and/or nutrition professional for any questions. Relying on any information provided in this blog is solely at your own risk, and ICICI Lombard is not responsible for any effects or consequences resulting from the use of the information shared.