Now, citizens above 65 can purchase health insurance. Check out new rules

In a huge relief for all Indians above the age of 65, the insurance regulator, Insurance Regulatory and Development Authority of India (IRDAI), has directed insurance companies to offer their usual health policies to everyone, including senior citizens, students, and children, reported the Indian Express

This comes after Centre, in its manifesto, had said "everyone over the age of 70 years" would be brought under the government’s Ayushman Bharat health insurance scheme.

According to the IE report. IRDAI has told insurers to “design products specifically for senior citizens, students, children, maternity and any other group."

Sharad Mathur, MD & CEO, Universal Sompo General Insurance Company, said the move will benefit both senior citizens and working adults who are caring for aging parents. The scheme will encourage more Indians to secure their loved ones against serious medical conditions and illnesses.

Rupinderjit Singh, Vice President-Retail Health, at the insurtech company ACKO, said “companies can build new products or enhance existing products offering comprehensive coverage to the entire family, including parents, instead of the current approach of restrictive offering for senior citizens."

What can be the health insurance benefits a senior citizen can look for?

People without medical issues should seek out the most extensive insurance coverage available, which includes full payment of bills and minimal or nonexistent waiting periods.

IE quoted ACKO’s Singh, who said thats customers with existing health issues should evaluate many options and should "consider the network coverage, room rent limit, disease sub-limits, consumable cover, and other policy terms and conditions which may curtail payouts at the time of claim."

What issues could possibly rise?

As insurers may not be enthusiastic about catering to the 65-plus age bracket, and the terms and conditions of their insurance policies may not be as favourable.

A senior citizen who may now have the opportunity to buy health insurance will likely encounter stringent terms, exclusions, and possibly high premiums.

Concidering a person from age group 65 plus can have pre-existing health conditions; insurers will carefully evaluate the profitability, sustainability, and scalability of their policies.

Check-ups needed to renew?

IRDAI has proposed that insurers should refrain from requesting medical examinations or new proposal forms during the renewal process if the sum insured remains unchanged.

Insurers are encouraged to acknowledge improvements in the insured individual's risk profile to eliminate additional charges at renewal. Reportedly, currently, insurers commonly request senior citizens to provide medical reports upon renewal and may increase premiums if new medical conditions are identified.

IRDAI suggests that insurers establish a dedicated channel to handle health insurance claims and grievances specifically for seniors.

Can an insurer refuse an insurance renewal?

As per IRDAI, insurers should not refuse to renew a health insurance policy solely because the insured has made one or more claims in previous policy years. However, this guideline does not apply to policies that terminate after the payment of benefits covered under the policy, such as critical illness policies.

IRDAI emphasises that policies should be renewable except in cases of proven fraud, non-disclosure, or misrepresentation by the insured.

What is the waiting period?

IRDAI has stipulated that the waiting period for pre-existing diseases disclosed by the customer should not exceed 36 months for policies with continuous coverage under the policy.

“Insurers may endeavour to have smaller pre-existing-disease waiting periods and specific waiting periods in health insurance products,” it reportedly said.