In what could be a significant benefit for customers, a panel set up by the insurance regulator has recommended a standardised list of just 17 pre-existing diseases that could be excluded from health insurance policies.

Further, diseases such as Alzheimer’s, Parkinson’s, AIDS/HIV infection, morbid obesity, if contracted after buying a health cover, cannot be excluded.

The standardised list of 17 permanent exclusions include epilepsy, congenital heart disease, cerebral stroke, chronic liver and kidney diseases, hepatitis B, Alzheimer’s, Parkinson’s, HIV and AIDS, loss of hearing, and physical disabilities.

“The proposer’s consent is mandatory so that the proposer may take an informed decision,” said the report of the working group set up by the Insurance Regulatory and Development Authority of India (IRDAI), which has also given the exact classification, or ICD code, to ensure there is no scope for “subjective interpretation” by insurers at the time of claim settlement.

Waiting period

The working group has also suggested a four-year waiting period for inclusion of any ailment in the health cover against the current average two-year waiting period.

However, for conditions such as hypertension, diabetes and cardiac problems, the committee has said that the waiting period should not be more than 30 days.

“It is viewed that the clauses are open-ended and not specific,” the report observed.

To ensure that people with serious pre-existing diseases, including those with disabilities, can get health insurance, the committee has also suggested that insurers can include permanent exclusions with due consent of the proposer or customer.

“This could mean that people such as cancer survivors, who find it extremely difficult to get health cover, may now be able to get policies with exclusion for such conditions,” said an insurance company executive.

Significantly, in keeping with medical advances, the panel has also said that new treatments such as balloon sinuplasty, deep brain stimulation, oral chemotherapy, immunotherapy, robotic surgeries, and stem cell therapy may be included in health covers.

IRDAI is likely to come out with its final report by early next year and the benefits could kick in from 2019-20.

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