Taking a big consumer-friendly move, the Insurance Regulatory and Development Authority of India (IRDAI) intends to standardise the number of health conditions and medical procedures excluded from health insurance policies. This will result in the fact that, now, your insurance policy will cover more diseases in the future.
To keep things in motion, the regulator 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.
Reportedly, IRDAI said "It is desired that the industry adopts a uniform approach while incorporating the 'exclusions' as part of product design as well as for the wording of the exclusions. The committee will also keep in check certain exclusions which will not be allowed at all.,"
The purpose of standardisation is to increase the existing scope of insurance policies. This action was further boosted by the 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”. This brings to light that most health insurance plans do not include or cover pre-existing diseases, cosmetic and dental surgeries, pregnancy, vaccination, intentional injuries, HIV-AIDS, etc.
Recently, there has been an increase in demand for health insurance which has led to increase in the number of policies being offered. With such a high number, it is better that the health insurance industry adopts a uniform approach while incorporating ‘exclusions’ and also the language associated with the same. Many times, policyholders are not able to understand the language that is being used in the policy. The committee seeks to simplify the terminology and wordings involved.
A few objectives which the IRDAI aims to achieve through standardization are:
- Rationalise the exclusions by minimising the number to enhance the scope of health insurance coverage granted.
- Provide a uniform approach for incorporating medical exclusions.
- Standardize the language and wording used by insurers with respect to their ‘exclusions’.
- Remove exclusions that disallow coverage with respect to new modalities of treatments and technologically advanced medical treatments.
- Study the scope of allowing exclusions specific to individuals with certain diseases.
