New Health Insurance Rules 2020

From October 1, 2020, Health Insurance Policies are set to be more transparent and accessible for all the policyholders. The Insurance Regulatory and Development Authority of India Limited (IRDAI) has issued a set of new Health Insurance rules that will be implemented across all the policies. According to experts, these rule changes will benefit the policyholders, but there are fair chances that the premium of your policy may go up by 5% to 20% on average. Apart from these changes, the IRDAI has already introduced several changes in the rules related to Health Insurance Policies in the last year to make all these products more customer-friendly.

So, what is the reason behind the implementation of these fresh Health Insurance Rules by IRDAI? The answer is to bring the much-needed ‘Standardization’ in Health Insurance Products as there are several products available for customers, and people often find themselves confused. These fresh Health Insurance Rules aim to make a Health Insurance policy more inclusive and attractive for customers. The hike in the premium rates will be because of the revamped products after the implementation of new rules by the IRDAI.

These new rules will be regarding the Waiting Period after taking a Policy, Claim acceptance and Rejection by the Companies, Inclusion of New Illnesses, change in the pre-existing illnesses, etc. We will be covering all the fresh Health Insurance Rules that are going to take effect from October 1, 2020, in this article. Keep reading to know more.

What are the New Health Insurance Rules to be Implemented from October 2020?

We are showing you all the new rules that are going to be incorporated in the Health Insurance Policies. These policies must be filed by the Insurers on or after October 1, 2020, and for those existing products that are due for renewal from April 1, 2021. Please have a look.

1. There has been a lot of confusion among people about which disease is covered under a policy and which is not. The first thing that the IRDAI asked from the Insurers to standardize the exclusions. Diseases and medical conditions that are not covered under a policy will be the same for all Insurers.
2. If there has been a disease that has been diagnosed 48 months before the issuance date of your policy, it will be classified as a Pre-existing Disease. Other than this, if you develop any symptoms after 3 months of the issuance of your policy, it will also be categorized as a Pre-existing Disease.
3. From October 2020, a wider range of Diseases can be covered under a Health Insurance Policy. After the new Health Insurance Rules, many illnesses can be covered. Earlier, there were a total of 30 Illnesses not included to get any cover under the policy. This number has reduced to 17 which means two things — Now, there are more permanent illnesses that a policy will cover and because of this, the Insurance Companies may increase the premium amount by 5% to 20% as we said earlier.
4. Modern Treatment methods such as Oral Chemotherapy, Balloon Sinuplasty, Deep Brain Stimulation, Robotic Surgery, Stem Cell Therapy, etc, will be covered in the new Health Insurance Plan.
5. Several Health Insurance Policies do not cover Mental Illnesses until now. But after the implementation of new rules, rising issues like Mental Illnesses, Genetic Diseases, Psychological Illnesses, Neurodegenerative Disorders, etc, have also been included under the Health Insurance Plan.
6. Besides the inclusiveness and Standardization of Health Insurance Products, the IRDAI has also asked all the companies to ensure coverage for Telemedicine as this practice is becoming more common among customers due to the limited outdoor activity caused by COVID-19. People are choosing to consult doctors virtually rather than visiting the Clinic.
7. According to the New Health Insurance Rules, if a customer has been paying his or her premium for the last 8 years without any fail, the insurer cannot reject the claim after 8 years of premium being paid. Apart from this, policyholders also won’t need to go through a re-evaluation for their policies if they have paid a premium for 8 years.
8. The IRDAI has also advised insurers that the Pharmacy, Diagnostic, Consumables, and any other implants would not be included as medical expenses under any circumstances. So, this will make sure that you will get a full claim for all of them. However, you need to remember your overall claim amount may reduce due to this new inclusion of medical expenses.
9. The insurance regulator has categorized the ICU Admission as a ‘Single Category’ under the fresh Health Insurance Rules. So, there will be no deduction for the ICU Admission, which means patients would not have to bear the ratio reduction for ICU Charges. This can also result in the allocation of expenses for the Hospital Room Rent Package.
10. The best thing about these new Health Insurance Rules implemented by IRDAI is that now customers can choose their claim on having more than one policy. For example, if a customer has more than one Insurance policy, he or she can choose the claim. Moreover, if you have exhausted the overall claim amount from one policy and still have medical bills to pay, you can choose another policy for the remaining amount. With this, there will not be any burden on the policyholder’s pocket.
11. According to the new rules regarding Health Insurance, a claim can be rejected and accepted within 30 days.
12. If you want to switch to some other Health Insurance Schemes from your current ones, you don’t need to serve a new waiting period for this new Scheme. Because of the new Health Insurance Rules, the older waiting period will apply to your new scheme.