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What’s New

03-06-2020

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FAQs

Health Insurance policies are offered by all Life, General and Health Insurance companies that are registered with IRDAI. The names of the Insurance companies that are registered with IRDAI are available in IRDAI website www.irdai.govl.in. Standalone Health Insurance Companies also offer Personal Accident Policies, Domestic Travel Policies and Overseas Travel Policies.

Section 2 (6C) of Insurance Act, 1938 defines Health Insurance Business as under:

"health insurance business" means the effecting of contracts which provide for sickness benefits or medical, surgical or hospital expense benefits, whether in-patient or out-patient travel cover and personal accident cover "

The Authority, as part of its administration of Health Insurance Business notified IRDAI (Health Insurance) Regulations, 2016 (hereafter referred as Health Insurance Regulations, 2016). In accordance to the provisions of Regulation 12(i) titled "Entry and Exit Age" all health insurance policies shall ordinarily provide for an entry age of at least up to 65 years. There are also Health Insurance Products that offer Health Insurance Coverage beyond age 65 years. In accordance to the provisions of Regulation 12(ii) once a proposal is accepted in respect of a health insurance policy (except Personal Accident and Travel Policies) and a policy is issued which is thereafter renewed periodically without any break, further renewal shall not be denied on grounds of the age of the Insured. Thus, health insurance policies are lifelong renewable.

Offering health insurance coverage to any person who was already suffered / has been suffering from any disease / illness is subject to underwriting policy of an insurer. It is also to be informed that providing coverage for those persons who were cured of any specific illness / disease is subject to product design of the Insurers. Insurers design products keeping in view certain factors such as viability and self-sustainability of products and the needs of the intended target market segment.

As part of Guidelines on Standardization IRDAI has already defined Pre-Existing Disease. A Pre-existing disease is defined as under (reproduced verbatim).

Pre-Existing Disease means any condition, ailment or injury or related condition(s) for which there were signs or symptoms, and I or were diagnosed, and I or for which medical advice I treatment was received within 48 months prior to the first policy issued by the insurer and renewed continuously thereafter. (Life Insurers may define norms for applicability of PED at reinstatement).

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