Mental, genetic ailments eligible for health cover under new Irdai norms

All health covers filed and cleared after April 1, 2019 must adhere to norms; existing policies not in adherence shall not be offered and promoted April 1, 2020 onwards

The Insurance Regulatory and Development Authority of India (Irdai) has listed diseases that can’t be excluded from health insurance policies. It includes neurodevelopmental disorders, mental illness problems, psychological disorders, genetic diseases, puberty- and menopause-related disorders.

The insurance regulator said all health covers filed and cleared after April 1, 2019, have to adhere to the guidelines issued. And, all existing health covers which are not in adherence with the guidelines would not be offered and promoted from April 1, 2020, onwards.

With the number of health insurance companies and insurance products increasing in the market, the regulator wants the industry to adopt a uniform approach while incorporating exclusions in their products.

Also, any expense incurred by the policyholder for an illness within 30 days from the commencement of the policy will not be covered, except for claims after an accident. However, this will not be applicable for a policyholder who has continuous coverage for more than a year.

The regulator has also directed that no health insurance policy can be contested after completion of eight years, which is called the moratorium period of health covers, except for cases like frauds or permanent exclusions specified in the policy contract.

The insurers will also have to cover patients on artificial life maintenance, even when there are no chances of the patient recovering and not getting back to their previous health condition. However, expenses would only be covered up to the date of confirmation by the treating doctor.

The regulator has also named diseases that can be permanently excluded. The list consists of diseases like Alzheimer's disease, Parkinson's disease, malignant neoplasms, epilepsy, pancreatic diseases, chronic kidney disease, HIV & AIDS among others.

Insurers can incorporate waiting periods for any specific diseases but only up to four years. However, subject to product design, insurers are also allowed to impose sub limits or annual policy limits for specific diseases be it in terms of amount, percentage of sums insured or number of days of hospitalisation/ treatment in the policy, Irdai said.