IRDAI panel wants several exclusions in health cover lifted

The Insurance Regulatory and Development Authority of India (IRDAI) is expected to free up healthcare policies from several exclusions and broad base health cover, in a move that would substantially raise health insurance costs.

A panel constituted by the Insurance Regulatory and Development Authority of India (IRDAI) has called for scrapping many exclusions that are in place in currently available health covers, in order to get them more broad-based.
If the insurance regulator is to accept the recommendation, the current health care policy premiums will bring in losses for insurance companies. Insurers will have to review their pricing, which may lead to reworking of the premium.
Alternatively, insurance companies may shift focus to preventive aspects of the business so as to reduce hospitalisation charges.
The regulator is expected to take a decision on the recommendations soon.
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.
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 be 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.
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.
This may extend from 30days to 90 days or more, and in some instances, even years, depending upon the amount claimed.