In­sur­ance cos can no longer ex­clude sev­eral ill­nesses

The Times of India (New Delhi edition) - - Front Page - Rachel.Chi­[email protected] times­group.com

Bengaluru: In a move that will ben­e­fit lakhs of pol­i­cy­hold­ers, in­sur­ance com­pa­nies have been barred from ex­clud­ing ill­ness as­so­ci­ated with haz­ardous work ac­tiv­ity, ar­ti­fi­cial life main­te­nance, treat­ment of men­tal ill­ness, age-re­lated de­gen­er­a­tion and in­ter­nal con­gen­i­tal dis­eases.

The in­sur­ance reg­u­la­tor on Mon­day said age-re­lated ail­ments such as cataract surgery, knee-cap re­place­ments, Alzheimer’s and Parkin­son’s would also have to be cov­ered. Also fac­tory work­ers, work­ing with harm­ful chem­i­cals which im­pact health over a long-term pe­riod, can­not be re­fused res­pi­ra­tory or skin ail­ments that arise as a re­sult of work­place con­di­tions.

The IR­DAI has also stan­dard­ised ex­clu­sions — if an in­surer does not want to cover epilepsy, chronic kid­ney dis­eases and AIDS — there are spe­cific word­ings to be used and a spe­cific wait­ing pe­riod af­ter which cov­er­age would be­gin.

These guide­lines will greatly ben­e­fit pol­i­cy­hold­ers, who dis­close pre-ex­ist­ing con­di­tions, as IR­DAI has said, “Every health in­sur­ance prod­uct shall cover all pre-ex­ist­ing dis­eases dis­closed by the per­sons to be in­sured im­me­di­ately af­ter the ex­piry of the 48 months wait­ing pe­riod or such lower pe­riod as stip­u­lated in the prod­uct.”

Stan­dard­i­s­a­tion of health reg­u­la­tions will also help porta­bil­ity as the new in­surer can­not set un­due wait­ing pe­ri­ods. IR­DAI has said, “If a per­son trans­fers from one in­surer to the other — and has al­ready com­pleted in part some of the wait­ing pe­riod re­quire­ment — then the new in­surer may im­pose only the un­ex­pired/resid­ual wait­ing pe­riod not ex­ceed­ing 48 months from the date of first is­suance of port­ing out pol­icy.”

“Stan­dar­d­is­ing of word­ings of ex­clu­sions across all in­sur­ers will avoid any grey area and pro­vide bet­ter un­der­stand­ing to cus­tomers. In line with med­i­cal treat­ments evolv­ing and new meth­ods com­ing up, in­sur­ers will be able to cover pol­i­cy­hold­ers against them,” said Gur­deep Singh Ba­tra, head (re­tail un­der­writ­ing), Ba­jaj Al­lianz Gen­eral In­sur­ance.

But TPAs and bro­kers warn that while the move is pro-pol­i­cy­hold­ers, it re­mains to be seen how it will af­fect pric­ing. “This is def­i­nitely great news for millions of peo­ple who, till now, found it dif­fi­cult to ob­tain a cover. How­ever, a word of cau­tion as it might lead to a dras­tic in­crease in the pre­mi­ums if in­sur­ers faced ris­ing claims,” said Rahul Agar­wal, founder, Ideal In­sur­ance Bro­kers.

In Novem­ber 2018, a re­port was sub­mit­ted by a work­ing com­mit­tee to the IR­DAI that in­sur­ance com­pa­nies can­not ex­clude dis­eases like Alzheimer’s, Parkin­son’s, HIV/AIDS and mor­bid obe­sity. This move by the IR­DAI fol­lows the rec­om­men­da­tions of the work­ing group.

Re­lief for pol­i­cy­hold­ers

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