10 New IRDAI Health Insurance Guidelines in 2024

Health insurance penetration in India is far lower than it should be. A significant chunk of the Indian population is confused about when and for what they will be covered and, hence, hesitates to buy a policy. To clear their confusion and change their hesitation into purchase, IRDAI has issued several new guidelines in 2024, making health insurance more inclusive for all.

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      List of New Health Insurance Guidelines by IRDAI in 2024

      The Insurance Regulatory and Development Authority of India (IRDAI) has recently amended the existing rules for health insurance products. Take a look at the new health insurance guidelines under the IRDAI (Insurance Products) Regulations, 2024 below that came into effect on April 1, 2024:

      1. No Age Limit to Buy Health Insurance

        The IRDAI has removed the maximum age limit for buying a health insurance policy in India. Earlier, insurance companies had to typically offer health insurance with an entry age of up to 65 years. However, the new guidelines eliminate this age reference, mandating insurers to provide health policies for people of all age groups. This guideline is especially helpful for senior citizens, who have the freedom to buy a comprehensive mediclaim policy whenever they want.

      2. Pre-existing Disease (PED) Waiting Period Reduced to 3 years

        As per IRDAI, the maximum waiting period for covering pre-existing diseases in health insurance has been reduced from 4 years to 3 years. This will enable policyholders to claim the treatment cost of pre-existing diseases, such as diabetes, hypertension, etc., after serving a maximum waiting period of 3 years. Moreover, it will prohibit insurance companies from rejecting PED claims after 3 years.

      3. Specific Disease Waiting Period Reduced to 3 years

        The IRDAI has also reduced the maximum waiting period for specific diseases/ procedures, like joint replacement surgery, under health plans from 4 years to 3 years. This will enable people to file health insurance claims for listed diseases/ procedures after waiting for a maximum of 3 years.

      4. Issue Policies to People with Severe Medical Conditions

        The insurance regulator has also prohibited health insurance companies from refusing health policies to people with severe pre-existing diseases, such as heart disease, cancer, renal failure and AIDS. This will ensure a more inclusive medical insurance ecosystem and increase its penetration in India.

      5. No Sub-Limits on AYUSH Treatment

        IRDAI has removed sub-limits on AYUSH treatments. With this guideline, policyholders will be able to claim the cost of treatments availed through Ayurveda, Yoga, Naturopathy, Siddha, Unani and Homeopathy systems of medicine up to the sum insured limit.

      6. Customized Plans for Specialized Groups like Senior Citizens

        The insurance regulator has asked insurers to design customized medical insurance products for senior citizens, children, maternity, students and other groups. This will encourage insurers to diversify their product portfolio and enable people from these specialized groups to choose the best health insurance plan specific to their needs.

      7. Create a Dedicated Support Channel for Senior Citizens

        The IRDAI has also asked insurers to formulate a specialized channel to handle the claims and complaints of senior citizens. This will ensure a more responsive and tailored approach to meet the requirements and settle the grievances of senior citizens.

      8. Moratorium Period Reduced to 5 years

        As per the latest IRDAI notification, the moratorium period in health insurance has also been cut significantly from 8 years to 5 years. This prohibits insurance companies from rejecting claims based on non-disclosure of pre-existing diseases or misinterpretation after 5 years of continuous coverage unless it is a case of fraud.

      9. No More Indemnity-based Policies

        The IRDAI has directed insurers to issue only benefit-based policies to cover hospitalization expenses and prohibited them from introducing indemnity-based policies. This will ensure that a fixed sum is paid to policyholders upon the diagnosis of a covered disease.

      10. Multiple Claims Across Various Insurers

        The insurance regulator has also allowed people with benefit-based policies to file multiple claims with several insurers. This will ensure more flexibility and wider options for policyholders when diagnosed with a disease.

      Summing It Up

      The IRDAI has made a few major changes to how health insurance functions in India. These pro-customer amendments are expected to make medical insurance more inclusive for all specialized groups, reduce coverage uncertainty and increase people’s trust in insurers. But more than anything, these changes are expected to increase insurance penetration in India.

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