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About Health Insurance

As per the Financial Express, ‘India is one of the least insured countries with only 20% of people having any kind of health insurance’.

As per Business Today, ‘the insurance penetration in India stands at 3.7% of the GDP in comparison to the world average which stands at 6.31%. The life insurance sector is growing at 11% to 12% while general insurance is growing at 18% per annum. For health insurance, the average growth rate is 35% per annum’.



A health insurance policy is the starting point of financial plans. The same is advised by financial planners. A health insurance plan is the first thing you should purchase before putting money into your investment goals.

With the new government in place, there has been tremendous potential for growth in the health insurance industry. But even after the successive measures taken by the Government of India, we still have a significant population which does not have adequate access to good healthcare.

In order to provide universal healthcare to the entire population, the Insurance Regulatory and Development Authority of India (IRDAI) along with the Government of India has introduced certain changes in the health insurance sector for 2019. The IRDAI has proposed to make health insurance more user-friendly.
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Age limit and AYUSH treatment

To begin with, IRDAI has issued a draft for standard health insurance plan with basic sum assured of ₹50,000 to ₹10 lakhs. The draft defines the profit structure applicable to individual insurance consumers with no higher regulation. Under this draft, the minimum age of entry for the principal insured is 18 years while the maximum age of entry is 65 years of age along with lifelong renewability. There is no maximum exit age. The new basic standard health insurance plan will also have to provide cover for expenses incurred on treatment taken through Unani, Sidha, Homeopathy and Ayurveda systems of medicine. But the expenses are subject to fixed and standard sub-limits on the sum insured and the plan cannot be combined with critical illness cover or benefit based cover.
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Shorter Waiting Period

A waiting period is the time period under which you cannot make a claim for a particular ailment. This is usually applicable for pre-existing diseases. As per the latest draft, insurance providers will not be able to prescribe waiting periods of one to four years for ailments such as cardiac conditions, hypertension and diabetes (lifestyle diseases). There will just be a cap of 30 days on the waiting period, unless these ailments are pre-existing.


Incontestable Post Eight Renewals

Keeping frauds aside, the insurance providers will also not be allowed to question claims on the grounds of nondisclosures at the time of taking the first health insurance policy after eight years of continuous renewals. This call will certainly relieve some stress off the mind of the client WHO has been consistent in premium payment.
Mandatory Coverage

All health related diseases and ailments acquired post issuance of the health insurance policy will be covered and cannot be permanently excluded (except infertility and maternity). The list of exclusion comprises of ailments like Alzheimer’s disease, Parkinson’s disease, AIDS/HIV and morbid obesity.


Cover against Severe Health Conditions

Earlier, people with physical disabilities, cancer survivors and epilepsy patients were denied health insurance cover even for unrelated ailments. Recently, IRDAI has expressed that insurance suppliers can got to supply insurance plans to such people (pre-existing diseases won't be lined throughout the policy tenure). For this purpose, IRDAI has released a report which lists 17 conditions. It includes kidney diseases, chronic liver, valvular heart and congenital disease, HIV/AIDS. Conditions which involve a history of heart-related ailments and knee replacement will not be covered.
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Clearer Definition of Pre-Existing Diseases

The IRDAI has told insurance companies to provide a simpler definition (Standardization) of pre-existing diseases to prevent any disputes over interpretation between the policyholder and insurer. The urged definition is: any condition, ailment, injury or disease that is diagnosed before buying the first policy, for which medical advice or treatment was recommended by, or received from, a physician.


Cumulative Bonus (CB)

Sum insured shall be increased by 5% in respect of each claim free policy period, provided the policy is continuously renewed to a maximum of 50% of the sum insured.


Deductibles

No deductibles are permitted under the base cover.
Reportedly, IRDAI aforesaid "It is desired that the trade adopts a standardized approach whereas incorporating the 'exclusions' as a part of product style likewise as for the verbiage of the exclusions.”

For this purpose, IRDAI has set up a ten-member team, headed by Suresh Mathur, Executive Director (health) at IRDAI, to provide a detailed list of medical exclusions that are prevalent in current health policies. The committee will detain check sure exclusions which can not be allowed in the least.

This entire course of action was accelerated by Delhi High Court’s decision which stated in February this year, that insurers can’t exclude genetic disorders and congenital anomalies, calling it a “violation of citizens’ right to health”.
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