Health Cover Gets Better, Broader

A spate of regulatory reforms have been brought recently and much more is in the pipeline.

In terms of providing cover, the reach is being expanded by revisiting present exclusions, which are detrimental to the interests of the policy holders.

The Insurance Development and Regulatory Authority of India (IRDAI) is now looking at banning key exclusions to protect the interest of health insurance policy holders on the basis of recommendations of its working group.

If approved, in future, no health insurance policy should incorporate exclusions such as diseases contracted after buying the health cover, injury or illness associated with hazardous activities, and impairment of a person’s intellectual faculties from drugs and stimulants or depressants prescribed by a medical practitioner.

The regulator is also looking at streamlining key issues concerning expenditure incurred by critical-care patients and its cover under health policies.

On the claims front too, some novel moves are on. The regulator is considering the option, whereby the policyholder can receive the amount in lump-sum or in equated instalments.

This will not be a default mode, but should be implemented only if a customer opts for it.

The periodicity of instalments could be monthly, quarterly, bi-annual, and annual. The claim payment period could be up to a maximum of five years, and instalments should be spread over the payment period.

The waiting period is also likely be reduced. The regulator is examining the possibility of reducing the waiting period for lifestyle diseases related to hypertension, diabetes and heart ailments to less than 30 days. Generally, the waiting periods is now 90 days or more.

Gross premium underwritten by 31 non-life insurance companies, which also has health insurance as a component, increased 12.91 per cent to ₹ 1,70,111 crore in FY19 against ₹1,50,662 crore in the previous fiscal.

The standalone private health insurers witnessed a 37 per cent increase in their combined premium to ₹11,368 crore in the financial year ended March 2019, against ₹8,314 crore a year ago.