BIG DECISION by IRDAI, regulator issues these important guidelines for insurers - What companies and customers must know

Big decision by IRDAI! In a bid to rationalise and standardize the exclusions in health Insurance Contracts that every Insurer shall comply with the Insurance Regulatory and Development Authority in India (IRDAI) has issued guidelines to the health insurance companies. These guidelines are applicable to all General and Health Insurers offering indemnity based health insurance (excluding PA and Domestic or Overseas Travel) policies offering hospitalisation, domiciliary hospitalisation and day care treatment. Health Insurance has undergone various changes and improvements over the years. The  IRDAI regulations and the TPA (Third Party Administrators) regulations have brought in standardization of various definitions or formats in the health insurance industry to promote uniformity keeping the customer in focus. With the increase in the number of health insurance companies as well as health insurance products in the market, it has been desired that the health insurance industry adopts a uniform approach while incorporating exclusions in the health insurance products.

The IRDAI guidelines direct insurers that they will have to cover illnesses associated with the treatment of mental illness, age-related degeneration, internal congenital diseases, hazardous work activity and artificial life maintenance. This development is anticipated to benefit lakhs of policyholders.

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The provisions of these IRDAI guidelines shall be applicable in respect of all health insurance products (Other than Personal Accident, Domestic and Overseas Travel Policies) (both Individual and Group) referred to in Clause (2) above filed on or after 01st October 2019. All existing health insurance products that are not in compliance with these Guidelines shall not be offered and promoted from 01st October 2020 onwards.