Post-policy health conditions must be covered

Print Friendly, PDF & Email

Context:

  • All health conditions arising after the inception of a health insurance policy should be covered and cannot be permanently excluded, a committee has recommended to the insurance regulator.
  • This is among the key recommendations of a committee appointed to look into standardisation of exclusions under health insurance policies. The panel has submitted its report to the Insurance Regulatory and Development Authority of India.

Other recommendations made by the committee

  • All health conditions acquired after policy inception, other than those that are not covered under the policy contract (such as infertility and maternity), should be covered under the policy and cannot be permanently excluded.
  • Thus, exclusion of diseases contracted after taking the policy such as Alzheimer’s , Parkinson’s , AIDs/HIV infection, morbid obesity, etc., cannot be permitted
  • The panel recommended that there should not be any permanent exclusions in the policy wordings for any specific disease condition(s), whether they are degenerative, physiological, or chronic in nature.
  • It has initially recommended a list of 17 conditions (including epilepsy, heart ailment congenital, heart disease and valvular heart disease, chronic liver diseases, loss of hearing, HIV & AIDS, Alzheimer’s, Parkinson’s) for which insurers can incorporate permanent exclusions if they are pre-existing at the time of underwriting
  • The Working Group recommends that insurers may be allowed to incorporate waiting periods (duration when a claim is not admissible) for any specific disease condition(s) however to a maximum of 4 years.

Source:TH