Currently available health covers are likely to get more broad-based soon with a panel constituted by the Insurance Regulatory and Development Authority of India (IRDAI) calling for scrapping many exclusions currently in place.
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 due to usage of drugs and stimulants or depressants prescribed by a medical practitioner, the panel said.
The panel has also addressed one of the key issues faced in relation to critical-care patients who fail to recover despite significant expenditure on treatment.
Providing for life support
Artificial life maintenance, including the use of a life-support machine, wherein such treatment will not result in a recovery or restoration of the previous state of health, should not treated as an exclusion “under any circumstances’’, the committee has said.
In the case of a patient in a vegetative state, as certified by the treating medical practitioner, expenses up to the date of confirmation by the treating doctor should be covered, it said.
Similarly, the cover should be extended for the treatment of mental illness and stress or psychological and neurodegenerative disorders besides puberty and menopause-related ailments.
Internal congenital diseases and genetic disorders are also not to be included under exclusions.
Curtailing waiting period
When contacted, Shanai Ghosh, Chief Marketing & Commercial, Strategy Edelweiss General Insurance, told BusinessLine that the suggestions, once implemented, will benefit customers.
Typically, health insurance policies have ‘wait periods’ for specific diseases. In the current draft, the regulator has advised that for lifestyle diseases related to hypertension, diabetes and heart ailments, the waiting period should not be more than 30 days.
“Usually, the wait periods tend to be 90 days or more, and in some instances, even years. Reducing this to 30 days is extremely beneficial to customers – all their claims beyond 30 days are now payable,’’ she said.
This will impact the loss ratios of the product which will, in all probability, go up. “Therefore, insurers will also need to review their pricing, which may lead to reworking of the premium,’’ Ghosh added.
In another fundamental shift, insurance companies will now focus on the preventive aspects of the business.
The regulator is expected to take a decision on the recommendations soon.