Effective from April 1st, 2024, IRDA has made significant changes to your health insurance policies. What are these changes in Health insurance?
On 1st April 2024, IRDA published a notification wherein certain important changes were made to your health insurance rules. Knowing these is very important. These changes will be effective from 1st April 2024 itself.
Latest changes in Health Insurance from 1st April 2024
# Moratorium period reduced
What is the moratorium period in health insurance policies?
After the completion of EIGHT continuous years under the policy no look back to be applied. This period of eight years is called as moratorium period. The moratorium would be applicable for the sums insured of the first policy and subsequently, completion of 8 continuous years would be applicable from the date of enhancement of sums insured only on the enhanced limits. After the expiry of the Moratorium Period, no health insurance claim shall be contestable except for proven fraud and permanent exclusions specified in the policy contract. The policies would however be subject to all limits, sub-limits, co-payments, and deductibles as per the policy contract.
For a detailed understanding of this, I suggest you to refer my earlier post “Health Insurance Claims can’t be rejected after 8 Yrs“.
Now, effective from 1st April 2024, this period is reduced to 60 months (5 years) than earlier 96 months or 8 years.
“After completion of sixty continuous months of coverage (including portability and migration) in a 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 of sixty continuous months is called as moratorium period. The moratorium would be applicable for the sums insured of the first policy. Wherever, the sum insured is enhanced, completion of sixty continuous months would be applicable from the date of enhancement of sums insured only on the enhanced limits.”
# Definition of Pre-Existing Disease
When buying health insurance, if the policyholder has pre-existing conditions such as diabetes, high blood pressure, thyroid issues, etc., they are categorized as pre-existing diseases.
Any condition, ailment, injury or disease –
- that is/are diagnosed by a physician not more than 36 months prior to the date of commencement of the policy issued by the insurer; or
- for which medical advice or treatment was recommended by, or received from, a physician, not more than 36 months prior to the date of commencement of the policy.
Earlier the maximum period was 48 months. Now it is reduced to 36 months. It means if any diseases are diagnosed and completely cured 36 months before the commencement of the policy will not be any waiting period and such diseases are not considered pre-existing diseases.
However, it does not mean you can hide such information. If insurance companies ask for diseases that are more than 36 months old, then you must provide them. In simple, don’t hide any diseases whether they are cured before 36 months or after 36 months. However, the new waiting period will be 36 months than the earlier 48 months.
# Specific Waiting Period
Health insurance policies usually impose a waiting period of one to four years for certain specified ailments and procedures, like ENT disorders, hernia, osteoporosis, joint replacement surgery, cataracts, and more. Medical expenses related to these conditions or procedures are eligible for coverage only after the completion of the designated waiting period.
“Specific waiting period” means a period up to 36 months from the commencement of a health insurance policy during which period specified diseases/treatments (except due to an accident) are not covered. On completion of the period, diseases/treatments shall be covered provided the policy has been continuously renewed without any break.
Earlier this waiting period was also the maximum of 48 months. Now it is reduced to 36 months.
# Maximum waiting period for pre-existing diseases
As the definition of pre-existing diseases was reduced from a maximum of 48 months to 36 months, the maximum waiting period for pre-existing diseases was also reduced to a maximum of 36 months.
“Waiting period for pre-existing diseases disclosed by the persons to be insured shall be a maximum of up to 36 months of continuous coverage under the Health Insurance policy. Insurers may endeavor to have a lesser preexisting disease waiting period and specific waiting period in the health insurance products.”.
Conclusion – From the policyholder’s perspective this is a big relief. But we have to look for how the insurance companies will look into these changes as these changes may increase their claim costs.
