It’s not uncommon to see senior citizens deferring or avoiding getting treated in a hospital, because they did not have health insurance cover. That is the uncomfortable truth confronting several elderly people in the country.

But this situation is poised for a change following a recent decision by the Insurance Regulatory and Development Authority of India (IRDAI) to remove the upper age limit of 65 years for a new health insurance policy.

And while the move is being hailed by industry-watchers, its real test will be in the health insurance covers that get rolled out in a few months, and the premiums and benefits they bundle for the elderly.

Manisha Karmarkar, Chief Executive at Pune’s DPU Super Specialty Hospital, sees the revision in norms as significant enablers that will empower one of the most sensitive demographics to secure them against major health concerns.

“Earlier, this age group was not able to avail of treatment benefits from advanced healthcare facilities owing to multiple reasons, the primary concern being unaffordability. With the new reform, this problem has been eradicated from the ecosystem, marking a historic landmark in the confluence of the healthcare and insurance industry,” he said.

Low on awareness

Awareness about health covers is not very much seen among the geriatric population including those hailing from middle class families, says the president of a large corporate hospital chain, unwilling to be named. However, he hoped, the removal of the upper age limit to buy new policies would now motivate them to go in for health covers.

Prasun Sikdar, Chief Executive Officer, ManipalCigna Health Insurance, calls the decision a transformative stride by the IRDAI, in terms of creating an inclusive healthcare ecosystem. “The removal of the age cap on health insurance policies will provide senior citizens with complete peace of mind, knowing that they have access to quality healthcare when they need it most during the golden years of their life,” he says.

ManipalCigna, recently launched its ‘Prime Senior’ plan that gives flexibility with lower waiting periods and provides coverage for pre-existing disease conditions from the 91st day onwards. Understanding the evolving needs of seniors and the rising medical inflation, he says, is an opportunity to extend “unwavering support” to the elderly in safeguarding their health and well-being.

Some of the broad features outlined by IRDAI are yet to be designed by the insurance companies to include the reduction of waiting period from 48 months to 36 months and coverage of all pre-existing health conditions after the waiting period.

“Insurers may endeavour to have lesser pre-existing disease waiting periods and specific waiting periods in the health insurance products provided that the above waiting period norm of pre-existing disease shall not be applicable for Overseas Travel Policies,’’ IRDAI said in its revision of norms.

The moratorium applicable for health insurance policies issued by general and health insurers is the completion of sixty continuous months (5 years) of coverage (including portability and migration) in health insurance policy — following which, no policy and claim shall be contestable by the insurer on grounds of non-disclosure, misrepresentation, except on grounds of established fraud, the new norms say.

Moratorium period is a safeguard clause for the policyholders. Once the moratorium period is over, insurers cannot reject a claim on the grounds of non-disclosure, or misrepresentation. Insurers have to establish a case of fraud to reject a claim.

New Heights
Health insurance premium crossed the landmark of ₹1-lakh crore, closing at ₹1.09-lakh crore in FY24, out of a total non-life premium of ₹2.89-lakh crore.
Paving the way

The removal of the upper-age cap will have broader implications as it will open up doors to those above 65 years of age to other upcoming products like Bima Vistar, the first of its kind all-in-one affordable insurance product which is proposed to be mandated by the insurance regulator to be offered by all insurers to provide life, health and property cover. This comprehensive product was proposed by IRDAI Chairman Debashish Panda, part of the reforms to provide insurance coverage to all by 2047.

The next few months will reveal the challenges in drawing up the easy-to-adopt health insurance products for the elderly. The pricing of premiums for different disease profiles, such as cancer, could be on the higher side. But removing the age cap, for starters, has opened the gates for what was an otherwise no-go zone for health insurers.