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An insurance policy in India is a contract between an individual or entity (the policyholder) and an insurance company (the insurer), where the insurer agrees to compensate the policyholder or their beneficiaries for specified losses, damages, illnesses, or death in exchange for a premium.
In India, the insurance industry is regulated by the Insurance Regulatory and Development Authority of India (IRDAI), which ensures the protection of policyholders' interests and the healthy growth of the insurance sector. IRDAI made some necessary changes in Insurance Policy rules in January 2024.
List of New Health Insurance Guidelines by IRDAI in 2024
Health Insurance Plans for All Age Groups
The IRDAI has announced that there will be no age limits or the entry age limit for taking a health insurance plan. Initially, the age limit was sealed upto 65 years of age but not IRDAI has eliminated the age limit
Pre-existing Disease (PED) Waiting Period Reduced to 3 years
As per IRDAI, the new pre-existing disease waiting period was 4 years which is now reduced 3 years. This will enable insurers to take their claim just after 3 years .pre –existing diseases like diabetes, hypertension.
Specific Disease Waiting Period Reduced to 3 years
- The IRDAI has also specified that specific disease like joint replacement and other specified surgeries from 4 years to 3 years. The IRDAI's decision to reduce the waiting period for specific diseases like joint replacement and other surgeries from 4 years to 3 years is aimed at providing quicker coverage and benefits to policyholders undergoing these treatments. It's a positive move towards enhancing insurance accessibility and timely support for medical expenses related to these conditions.
- IRDAI has also taken steps to provide more inclusive insurance policies such that maximum numbers of people are included. People with more severe medical conditions like AIDS, renal failure , cancer can now be covered under insurance policy.
- All limits has been evoked for getting treatment under AYUSH. YUSH Treatment" means that the insurance policy does not impose specific caps or limits on the amount that can be claimed for treatments under these alternative medicine systems. Policyholders can choose treatments from any of the AYUSH systems without facing financial restrictions within the overall sum insured.
- Mandatory KYC for New Policies: IRDAI now requires Know Your Customer (KYC) documentation for all new insurance policies, including health, auto, travel, and home insurance. This rule aims to streamline customer identification and prevent fraud.
- Customer Information Sheet: Insurers must provide a customer information sheet that clearly explains policy details in simple terms. This is intended to help policyholders better understand their insurance coverage and terms.
- Moratorium Period Reduced: The moratorium period has been reduced from 8 years to 5 years. After this period, insurers cannot reject claims based on non-disclosure of pre-existing diseases or misinterpretation unless fraud is involved.
- Benefit-Based Policies Only: Insurers are now directed to issue only benefit-based policies for hospitalization expenses, rather than indemnity-based ones. This ensures a fixed sum is paid upon diagnosis of a covered disease, simplifying the claims process for policyholders.
- Dedicated Support for Senior Citizens: A specialized support channel for senior citizens has been mandated to ensure their claims and complaints are handled more efficiently and responsively.
- Insurance Trinity Project: This initiative includes Bima Sugam, Insurance Expansion, and Insurance Carrier products. It aims to simplify the purchase of insurance products, offer affordable coverage, and empower women through specific insurance products
These changes are designed to make insurance more accessible, transparent, and customer-friendly, ultimately increasing trust and insurance penetration in India. The reforms in insurance policy ensures accessibility, transparency, and customer satisfaction, aiming to build greater trust and increase insurance penetration. Global Jurix is one of the top most law firm in Delhi that can help you with many legal services corporate law, intellectual property rights (IPR) , litigation , finance and taxation, mergers and acquisitions , real estate law , environmental law. additionally, it provides legal consultation and representation , compliance and regulatory services , business setup and corporate services , trademark registration and protection , arbitration and mediation
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