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8 Big upcoming changes in health insurance to benefit policyholders

Published on Sept 16, 2020. EST READ TIME: 5 MIN   

The Insurance Regulatory and Development Authority of India (IRDAI) continuously strives to make insurance policies more customer-friendly. Over the years, many regulations and recommendations have played an essential role in boosting the growth of the insurance industry. In keeping with its continued efforts, the IRDAI issued new guidelines this year for insurers offering  health insurance . Let us learn about these changes.

  • More clarity: To provide policyholders simple-to-understand products, IRDAI asked insurers to standardise the terms and clauses in their indemnity-based health insurance policies and use the prescribed standard wordings provided by the regulator. These clauses are to be incorporated on or after October 1, 2020, in the new products filed by insurers and for existing products that are due for renewal from April 1, 2021. Similarly, for a policyholder who opts for room capping, they have to be told about the ‘associate medical expenses’. It is to make claim reductions more rational. The health insurance companies have also been asked to provide a list of Third Party Administrators (TPAs) to the policyholders and let them choose a TPA of their choice. Now, you will be able to make a more informed choice.

  • Coverage for telemedicine: The coronavirus outbreak has made social distancing the need of the hour. The Medical Council of India has issued guidelines enabling Registered Medical Practitioners to provide healthcare using telemedicine, i.e. the exchange of medical information from one place to another using the electronic mode of communication. Now, IRDAI has advised the insurers to allow claim settlement for telemedicine consultation.

  • Easy instalments: In 2020, IRDAI, for the first time, allowed policyholders to pay  health insurance premiums in instalments. You as a policyholder can now pay premiums on a monthly, quarterly or half-yearly basis. The downside is that you may get less free-look period for monthly or quarterly premiums compared to what you got while paying annual premiums.

  • Crystal-clear exclusions: IRDAI is taking note of the policy wording and making sure there is less ambiguity. It asked for the standardisation of health exclusions, including simplification of the definition of pre-existing diseases. This measure was brought in so that the policyholders, who are unaware of their medical conditions at the time of buying the policy, do not face the risk of claim rejection when they are diagnosed with a disease. The insurance companies were also asked to list out pre-existing conditions, which would not be covered up to a particular period of not more than four years from the start of the policy.

  • Priority given to mental health : Depression and anxiety are silent killers, and because mental health is not seen as a severe ailment, people do not seek treatment for that. However, IRDAI has been making efforts to change that. It has communicated to the insurers to include mental problems, genetic diseases, neurodevelopment disorders, and psychological disorders in the health insurance policies.

  • Upper age limit: IRDAI has allowed insurers to increase the maximum and minimum age limit for insurance policies.

  • Allowing treatment for medical emergencies in blacklisted hospitals: Now IRDAI has allowed insurers to reject claims for treatment by medical practitioners and healthcare facilities blacklisted by them. But there is an exception for treatment of accidents and emergency hospitalisation due to deadly ailments. However, as a policyholder, go through the list of such blacklisted hospitals and avoid them in other cases.

  • Other measures : It has been often observed that hospitals tend to charge more from patients who have insurance policies and the medical bills usually drain them of their sum insured. IRDAI has been mulling to stop this practice and is planning to standardise charges for some medical procedures.


 These measures, if implemented with full strictness, will work wonders in the life of a policyholder. All said and done; it’s always wise to have health insurance and nowadays, you can buy a health insurance policy online without stepping out, compare the health plans online and pick the one that meets your requirements. 

Disclaimer:  The above information is for illustrative purpose only. For more details, please refer to policy wordings and prospectus before concluding the sales.

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