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Insurance regulator IRDAI pushing companies to provide Health Coverage to All

Apr 23,2024

Mumbai: Insurance regulator Irdai is pushing companies to ensure that health covers are available to all age groups, as well as those with pre-existing diseases, mental health issues and women, to ensure that there is greater coverage and no one is denied the facility.

While the regulations have been tweaked, many are interpreting it to mean a mandate from the regulator to ensure that those over 65 are not denied health insurance. Sources told TOI without mandating detailed norms, Irdai is going to monitor how companies are going to respond to the new regulations issued recently.

“The idea is to ensure that appropriate products should come in the market. The regulator has left it to the market to decide the premium and other elements to address the requirements of the wider public,” said a source familiar with the deliberations in the Hyderabad-based regulatory agency.

So far, insurers have often denied health covers to first-time buyers who are over 60 years and very often refuse to renew insurance once a claim is made, even for the younger segment. While insurers are mandated to provide lifelong renewability of health insurance, they are not forced to offer insurance to first-time buyers beyond the age of 65. Many insurers have a maximum age of entry at 65, although some such as Star Health accept new proposals from even older people.

Besides, several prospective buyers are turned away citing “pre-existing disease”, leaving such consumers to fend for themselves without any insurance. “These risks can be covered which may mean a higher premium,” a source explained.

“Most citizens shy away from health insurance because they find the terms and conditions confusing, especially when it comes to pre-existing ailments as well as waiting periods. With these new guidelines, it is an endevour of the regulator to ensure standardisation to make life simple for the citizens when it comes to understanding of health insurance. The new regulation intends to make health insurance even more inclusive, especially for senior citizens, persons with disabilities and persons with chronic ailments,” said Tapan Singhel MD & CEO Bajaj Allianz General Insurance.

Sources said that there is no mandate yet asking companies to offer policies to all. Insurers say this would be a challenge while underwriting a first-time buyer of say 90 as the higher risk would make the policy prohibitively expensive. Already companies are facing an issue with drop out of healthy seniors whose premium breach 20 per cent of the sum insured once they cross 75 years.

Source: Healthworld

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