IRDAI eliminates age restrictions on health insurance purchase

As of April 1, 2024, the Insurance Regulatory and Development Authority of India (IRDAI) has abolished the age limit for purchasing health insurance policies, signaling a significant change in India’s insurance domain.

Previously, there existed a restriction where individuals aged above 65 years couldn’t acquire new health insurance policies. However, the recent regulatory amendments have removed this barrier, allowing individuals of any age to obtain fresh health insurance coverage.

In a notification released by the IRDAI, the importance of insurers broadening their service conditions to accommodate diverse demographic segments like senior citizens, students, children, and maternity needs was underscored. Insurers are encouraged to design customized products to address specific age-related requirements, fostering inclusivity in the healthcare framework.

This move reflects IRDAI’s dedication to enhancing accessibility and affordability of healthcare coverage across all age brackets. By lifting age restrictions, the regulatory body aims to spur innovation among insurance providers, prompting them to diversify and refine their product offerings.

Additionally, the IRDAI directive mandates health insurance providers to develop specialized policies tailored for senior citizens, along with establishing dedicated channels for handling their claims and grievances. This proactive approach seeks to effectively address the distinctive healthcare needs of elderly policyholders.

Industry experts have welcomed this regulatory change, recognizing its potential to expand healthcare coverage to individuals aged above 65 years. Insurers, guided by board-approved underwriting guidelines, now have the authority to extend coverage to senior citizens based on affordability and viability considerations.

In another significant reform, insurers are prohibited from rejecting policies for individuals with severe medical conditions such as cancer, heart or renal failure, and AIDS. The notification also reduces the waiting period for coverage of pre-existing conditions from 48 months to 36 months. Post this period, all pre-existing conditions must be covered, irrespective of initial disclosure.

Moreover, IRDAI has mandated a transition from indemnity-based health policies (which reimburse hospital expenses) to benefit-based policies, providing fixed payouts upon diagnosis of covered illnesses. This transition aims to enhance clarity and predictability in insurance offerings, ensuring policyholders receive timely and transparent benefits.

The comprehensive regulatory measures introduced by IRDAI herald a new era of inclusivity and transparency in India’s health insurance sector, enabling individuals of all ages to access comprehensive coverage and essential healthcare services. These reforms underscore IRDAI’s commitment to promoting consumer welfare and fostering a robust and responsive insurance ecosystem.