Health insurance policy: The new rules issued by IRDAI will be implemented from October 1

New Delhi: Insurance Regulatory and Development Authority (IRDAI) has asked insurers to standardized the medical conditions that are not covered under any of the policy. Any disease that is treated by a doctor within 48 months will be classified as existing diseases prior to the insurance of health cover. In addition, any condition that has symptoms within three months of the issuance of the policy will also be classified under pre-existing diseases. Treatment stress for mental illness will now be covered under health insurance policies. Policyholders are not deprived of the availability of health insurance coverage for modern treatment methods, insurers will ensure that the following treatment procedures are included in the health insurance policy contracts.

No rejection of claim after 8 years: In June last year, IRDAI stated that if the health insurance policy has been completed for eight years,means the policyholder has been paying premiums continuously for eight years, then no health insurance claim can be denied except the fraudulent one. Thus, customer’s health insurance claim will not be dismissed from the ninth policy year.

New definition of PED: As per the guidelines issued regarding standardization of health insurance policies, the definition of pre-existing diseases (PED) has to be changed according to the needs of the client. According to the guidelines issued, any disease that a doctor cures would be classified under PED 48 months before the release of health cover.

To ensure that policyholders suffering from pre-existing diseases receive adequate health insurance coverage, IRDAI mandates that insurers include permanent exclusions only after the consent of customers.

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