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IRDAI panel proposes standardisation of exclusions under health insurance

personal finance | Nov 5, 2018 7:34 AM IST

IRDAI panel proposes standardisation of exclusions under health insurance

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In an important move to make terms of health insurance policies transparent, a working group appointed by Insurance Regulatory and Development Authority (IRDAI) has recommended insurance companies to cover all health conditions acquired after the inception of the policy term.

In an important move to make terms of health insurance policies transparent, a working group appointed by Insurance Regulatory and Development Authority (IRDAI) has recommended insurance companies to cover all health conditions acquired after the inception of the policy term.

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According to the report submitted by the regulator appointed committee, insurance companies cannot exclude diseases like Alzheimer’s, Parkinson’s, HIV/AIDS and morbid obesity after the initiation of the policy term.
However, insurance companies will be allowed to incorporate a list of permanent exclusions under any policy. These are pre-existing illnesses, which will not be covered.
The committee has also mentioned 17 such exclusions, which include epilepsy, stroke, chronic liver diseases, chronic kidney diseases and Hepatitis B. Alzheimer’s and Parkinson’s disease are on the list and will not be covered if they are pre-existing conditions.
If the non-disclosed condition is other than that mentioned on the list of permanent exclusions, then the insurance company can incorporate an additional waiting period for a maximum period of four years from the date of detection.
Waiting period is the duration when a claim is not admissible. At present, the waiting period for most illness is up to two years and is decided by insurers based on past claims data.
IRDAI appointed committee has also recommended a moratorium period of eight years of continuous renewals after which the claim cannot be questioned based on non-disclosures or misrepresentations at the time of taking the policy.
All recommendations submitted by the IRDAI's working committee could be reviewed on a yearly basis.
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