Things to know about New Health Cover Rules

June 18, 2019 Finance Talk Valli Sarvani No comments

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.