Health Insurance for All Ages: IRDAI’s Progressive Decision to lift Age Limit of 65 years

In a significant move, the Insurance Regulatory and Development Authority of India (IRDAI) has abolished the age limit for purchasing health insurance policies, effective from April 1, 2024. This decision marks a departure from the conventional constraints that previously limited individuals in securing comprehensive health coverage. 

With the recent announcement, the regulatory body has eliminated the cap on buying health insurance policies, marking a significant departure from the conventional constraints that often limited individuals in securing comprehensive coverage

Furthermore, this move is poised to stimulate innovation within the insurance sector. Insurers are now incentivised to diversify their product offerings, catering to a broader spectrum of healthcare requirements.

The Age Barrier Lifted from Health Insurance

Until now, there was an age restriction of 65 years for buying new health insurance policies. This limitation left senior citizens, who often require healthcare the most, without adequate coverage. However, with the recent changes that have come into effect from April 01, 2024, anyone, regardless of age, is eligible to purchase a new health insurance and can now access cashless insurance benefits. It’s a welcome development that aims to enhance accessibility and affordability of healthcare coverage across all age groups.

Tailored Policies for Seniors

The IRDAI directive goes beyond merely lifting the age bar. It mandates health insurance providers to develop specialized policiescatering specifically to senior citizens. These tailored products are designed to meet the unique requirements of older individuals. Additionally, insurance companies are encouraged to establish dedicated channels for addressing claims and grievances related to senior citizens’ policies. This move fosters a more inclusive healthcare ecosystem, ensuring that seniors receive the attention and support they deserve.

Balancing Affordability and Coverage

While this decision opens up avenues for people above 65 years to seek health coverage, it’s essential to acknowledge that premiums for this demographic may be higher. The balance between affordability and comprehensive coverage remains crucial. The removal of the age bar is a step in the right direction, but insurance providers must strike a fair balance to ensure that seniors can afford quality healthcare without undue financial strain.

Also Read: General Insurance Industry in India: FY24 Insights and Challenges

Here Are Recent Notable Amendments in Health Insurance:

1. Policy Duration: Life insurance companies can now offer extended health insurance policies with a maximum tenure of five years, while general insurers and standalone health insurers are limited to three years.

2. Waiting Period for Pre-existing Conditions: The waiting period for coverage of pre-existing conditions has been reduced from 48 months (4 years) to 36 months (3 years). After this period, insurers cannot reject claims based on undisclosed pre-existing conditions, except in cases of fraud.

3. Claim Contestability Period: Insurers cannot challenge claims or policies due to non-disclosure or misrepresentation after 60 months (5 years) of continuous coverage, including cases of policy portability or migration, unless there is established fraud.

4. Policy Types for Life Insurers: Life insurance companies are restricted from offering indemnity-based health policies, which reimburse hospital expenses. Instead, they can only provide benefit-based policies that pay a fixed amount upon the occurrence of a covered condition or illness.

5. Bundling Health Plans with ULIPs: Life insurers have the option to bundle health insurance plans with Unit Linked Insurance Plans (ULIPs).

6. Premium Adjustments: Insurers cannot adjust premiums during the policy term, except at the time of renewal based on factors like age and risk. However, they can offer premium payment in installments for the convenience of policyholders.

7. Travel Insurance: Only general and health insurers are allowed to offer travel insurance policies.

8. AYUSH Treatment Coverage: There is no cap on the coverage for treatments under AYUSH systems (Ayurveda, Yoga, Naturopathy, Unani, Siddha, and Homeopathy), and these treatments will be covered up to the sum insured.

9. Multiple Claims for Benefit-based Policies: Policyholders with benefit-based health insurance plans can file multiple claims with various insurers, providing greater flexibility and options.

Industry Perspectives

Aashish Chaudhry, Managing Director of Aakash Healthcare, lauds this advancement. He emphasizes that the change will greatly benefit those in need of medical insurance, including children, maternity cases, and senior citizens. It serves the public interest by promoting longevity and well-being while advancing comprehensive insurance coverage.

Ratnesh Sinha, Head of Sales and Marketing at PSRI Hospital, highlights that this move will reduce the burden of medical expenditure for seniors in the age bracket. It’s a positive step toward better access to healthcare for our aging population.

The IRDAI’s decision to remove the age bar for health insurance purchases is a game-changer. It not only empowers seniors but also reflects a commitment to equitable healthcare for all. As we navigate the evolving landscape of healthcare, this progressive move ensures that age is no longer a barrier to comprehensive coverage, fostering a healthier and more secure future for our citizens.

Source: The HINDU