Health Insurance: No more wait more than three years for treatment of chronic diseases, new rule implemented
Health Insurance: As per IRDAI, health insurance covers the diseases or treatments mentioned above (except those caused by accident) for 36 months from the inception of the policy.
A major change has been made in health insurance. Under this, policyholders will no longer have to wait more than 36 months for treatment of chronic diseases. Earlier the waiting period for treatment of these diseases was 48 months. The new rule is effective from April 1, 2024.
Any pre-existing disease (PED) must be evaluated by a doctor 36 months prior to the start date of the health insurance policy issued by the health insurance company, or in accordance with medical advice, according to a recent notification from the Insurance Regulatory and Development Authority (IRDAI). Should treatment be advised, there will be no more waiting period than 36 months in these situations.
According to IRDAI, the indicated illnesses or therapies administered within the first 36 months of the health insurance policy's initiation (apart from those resulting from accidents) are not covered. After the policy's term has expired, these illnesses or treatments will be paid for, provided that renewals have occurred continuously and without interruption.
IRDAI has clearly stated that while purchasing the policy, buyers will have to give complete information about chronic diseases to the insurance company. On this basis, insurance companies can try to reduce the waiting period and specific waiting period for pre-existing diseases in health insurance products. However, this rule will not apply to foreign travel policies.
The regulator has said that insurance companies need to offer simple and easy-to-understand products which the policyholder can understand. There should be transparency and clarity in their wording, coverage and conditions. The interests of policyholders should be protected. All risks associated with the products should be appropriately considered in pricing.
IRDA said that the premium rates should be reasonable. Not be unfairly discriminatory and give fair value to insured premiums. Have the ability to take all risks. Any products that may be recalled if necessary.
