Things to know about New Health Cover Rules | Fusion - WeRIndia

Things to know about New Health Cover Rules

Things to know about New Health Cover Rules

The Insurance Regulatory and Development Authority of India (IRDAI) issued a new set of guidelines to ensure the health cover more inclusive than the past.

Here are some important points in the new health cover rules:

  • The new health cover rules of IRDAI state that health insurance companies cannot exclude children who suffer from autism, cerebral palsy, Down’s syndrome, dyslexia or stammering from the health packages.
  • The plans also should have to cover puberty issues as well as menopause-related issues like hormonal changes, excessive bleeding or flushing.
  • Furthermore, insurance companies cannot deny the claim on the clause of failure to follow medical advice.
  • The companies also cannot discriminate the clients based on gender or identity.
  • Insurers will have to cover patients who are kept on artificial maintenance even if the recovery of the patients is not assured by the doctors.
  • Now, robotic surgery and oral chemotherapy will also be covered.
  • These guidelines have to be followed by all health insurance policies filed and cleared after April 1, 2019.
  • The insurance companies cannot deny the claim on the condition of pre-existing ailments except for 17 conditions including kidney diseases, Alzheimer’s disease, chronic liver diseases, Hepatitis B, epilepsy, HIV/AIDS, and Parkinson’s disease.
  • Waiting periods for a specific disease cannot exceed four years. However, certain sub-limits or annual policy limits can be imposed by the companies.
  • The waiting period for lifestyle conditions such as hypertension or diabetes cannot be for over 30 days except if the health ailments are pre-existing and disclosed only after the policy is purchased.
  • The expenses incurred by patients for illnesses within 30 days from the commencement of policy will not be covered by the policies. However, this is not applicable to accidents.
  • A health insurance policy cannot be opposed after the completion of eight years, i.e. the moratorium period.
  • Certain adventurous sports like paragliding, dirt biking, whitewater rafting, go-karting, F1 racing and traditional sports like jallikattu and kamabla also will be covered in the packages.

Image Credit : Wellness Corporate Solutions / CC BY-SA 2.0

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