Recent Changes in Medical Insurance Policy!

From October 1 this year, the Insurance Regulatory and Development Authority of India (IRDAI) has introduced some major changes in the guidelines of Medical insurance policy which are in my opinion very customer friendly. Where the changes have been made will need time for further clarification, though, i tried to explain the most important one’s in this article. Please read it completely and feel free to ask your quires in the comment section.

No Rejection of Claim for Policies which are 8 Years old:

Incidents have happened with policy holders that after being a loyal customer for even last 10 years, policy house has somehow rejected their claim being their ailment not in the listed diseases mentioned in the policy terms. To take care of the issue IRDAI stated that whenever a health insurance policy has completed eight years, a claim cannot be rejected except for fraud and permanent exclusions mentioned in the policy.

This is certainly a big relief for the honest health insurance buyers. The proposal refers to these eight years as ‘Moratorium period.’ However, the policy terms and conditions must not include clauses under which some restrictions are given.

Various Modern treatments to be covered in health insurance:

By the advancement of medical science many modern treatments have been emerged in the recent years which is often suggested by doctors and surgeons these days. IRDAI has given directive to add some of them in the health insurance policy now onwards. Here is some of the treatments which they have notified:

Oral chemotherapy.
Balloon Sinuplast.
Immunotherapy- Monoclonal Antibody to be given as an injection.
Stem cell therapy.
Robotic surgeries.
Stereotactic radio surgeries.
Vaporisation of the prostrate (Green laser treatment or holmium laser treatment).
Bronchial Thermoplasty.

This is indeed an welcoming change made and will enable customers to avail such advanced way of treatment.

The definition of ”Pre-existing diseases” is now standardized:

Earlier it was not very clear what exactly pre existing illnesses are! The customer always had to remember his medical history and mention in the proposal form. If something comes up later which which was not disclosed while buying the policy, a high chance was there that the claim will be rejected.

Now, the IRDAI has made it clear that a pre-existing illness is an illness for which,

A doctor has advised you a treatment for any particular disease.
Or Doctor has diagnosed a disease.

In these two cases only, now it will be treated as a pre-existing illness, else not.

Paying health insurance premiums in EMIs:

In the month of June, amidst the COVID-19 outbreak, the IRDAI came out with a circular in for minor modifications in policies under general and standalone health insurance. As per the same, it has now been allowed that payment of health insurance premiums can be made in instalments.

Though It is completely up to the insurers to decide whether or not they will provide the facility of paying premiums in instalments to the customers. The premium payment mode can be monthly, quarterly or half-yearly, as decided by the insurer.

Cover for New Ailments added:

Various illnesses have been specified by the regulatory body that will now be covered under a regular health insurance cover which was not been mentioned under earlier guidelines. Like treatment for internal congenital diseases mental illness and artificial life maintenance will now be covered under a comprehensive health insurance plan.

The exclusions in health insurance policies has also been standardized, which means that if an insurer does not want to cover any particular ailments such as chronic kidney diseases, epilepsy and HIV/AIDS must use specific wordings as defined by the regulatory body in the policy terms. A waiting period of 30 days to one year have been prescribed, after which the coverage would begin for the illness.

Increase in Premiums due to these changes:

It is pretty obvious that with the new changes being applied the insurers are going the charge more for the same existing policies now. But considering the transparency which we have now it will be worth paying every extra rupee that may be charged.


Hope you have got a broad idea where the good changes have been made and basically which were very much required. Now it is on the insurers that how much higher they fix the policy rates in the future. It is for sure that the convenience and transparency will help the policyholders in the long run.

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