TL/DR –
According to the Insurance Regulatory and Development Authority of India (IRDAI), there is no longer an age limit for purchasing health insurance, enabling individuals above 65 to buy policies without restrictions. Waiting periods for pre-existing conditions have been shortened to five years, and after 60 months of continuous coverage, insurers are prohibited from denying claims due to non-disclosure or misrepresentation, barring proven fraud cases. The waiting period for pre-existing illnesses has also been reduced from four to three years, allowing those with conditions such as diabetes or hypertension to receive coverage for related hospitalisation claims after three premiums.
Ageless Health Coverage Introduced by IRDAI
Good news for individuals over 65 worrying about health insurance. A new rule change by the Insurance Regulatory and Development Authority of India (IRDAI) has eliminated the maximum age limit for purchasing health insurance policies. Previously, insurers could only offer coverage up to the age of 65. Now, there are no age restrictions for health insurance, allowing insurers to cover individuals above 65 years.
The health insurance regulations have seen significant improvements, with the changes favouring policyholders. The revised rules are effective immediately and will be incorporated into all new policies and existing ones upon renewal.
Shorter Waiting Periods and Enhanced Protection for Policyholders
Another vital change is the decrease in waiting periods for pre-existing conditions. Previously, insurers could impose waiting periods of up to 8 years for these ailments. Now, the waiting period has been reduced to 5 years. As a result, policyholders can breathe easy as after a continuous coverage for 60 months, insurers can no longer reject claims on the grounds of non-disclosure or misrepresentation, barring proven fraud cases.
As stated in IRDAI’s regulations, “After completion of sixty continuous months of coverage in health insurance policy, no policy and claim shall be contestable by the insurer on grounds of non-disclosure, misrepresentation, except on grounds of established fraud. This period is called a moratorium period.”
Waiting Period for Pre-existing Diseases Reduced
The waiting period for pre-existing diseases, such as diabetes or hypertension, has been cut down from 4 years to 3 years for both new and existing policyholders. Hence, coverage for related hospitalisation claims can be availed after paying three premiums, as compared to the past requirement of four.
These changes, including the reduction in waiting periods and the elimination of maximum age restrictions, have made health insurance policies in India more accessible and efficient. They have been designed to provide greater financial security and peace of mind to policyholders, ensuring that their healthcare needs are adequately met.
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