For instance, in one of the major shifts in rules for health insurance, IRDAI removed the ceiling of 65 years for buying a health insurance product early this year. This policy change further democratised the health insurance space, directing health insurers to cater to people from all age groups.
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Experts are of the view that new regulations will ensure significant shifts in how health insurance is structured in India and lead to greater trust and participation in health insurance among the public.
Parthanil Ghosh, Director & Chief Business Officer, HDFC ERGO General Insurance, shares his insights on various changes IRDAI has recently rolled out to make India’s health insurance landscape more inclusive and responsive to the evolving needs of policyholders.
Here are some of the major changes effected by IRDAI:
Cashless everywhere: Under cashless system, policyholders are eligible to avail cashless treatment at any hospital, even if that hospital doesn’t fall under their insurer’s network list. The cashless everywhere initiative gives the freedom to policyholders to choose any hospital based on their preference of treatment facility, physician and location, without having to worry about whether the hospital is empanelled under his or her insurer.
Quick approval of cashless claims: IRDAI has mandated insurers to grant final authorisation within three hours of receiving the discharge request from the hospital. In event of death of the policyholder, the insurer must process the claim settlement request swiftly and get the mortal remains released from the hospital immediately. It is a significant step towards protecting interests of policyholders and ensuring seamless claim experience for them. As a ‘Customer First’ organisation and a leading insurer in India, we at HDFC ERGO are already offering worldwide coverage and early discharge feature to our Optima Secure health insurance policyholders so that they don’t need to wait for long approval procedures during their discharge, and can be released as soon as the hospital signs the discharge summary.
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Change in no-claim bonus: Now a customer has a choice to opt for NCB either as increase in sum insured or by availing discount in the premium paid. It ensures more flexibility to the policyholder who can now avail NCB benefit as per their choice.
Reduction in waiting period for pre-existing ailments: There are certain diseases and medical conditions such as hypertension, diabetes, etc.; which were earlier covered by the health insurer after a waiting period of 4 years. However, now the waiting period has been reduced to 3 years, which ensures that customers can get insurance access sooner. At HDFC ERGO, we have already introduced 3 years waiting period for pre-existing diseases before the IRDAI mandate to offer seamless experience to our customers.
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Reduction in moratorium period: Once a health insurance policy stays active for five years, including portability and migration, the insurer can’t deny claims on grounds of non-disclosure or misrepresentation, except in cases of fraud. Earlier the tenure was 8 years.
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