A member of medical staff secures his face mask inside a operating theater at a hospital in Birmingham, U.K. (Photographer: Matthew Lloyd/Bloomberg)

IRDAI Wants To Reduce Conditions Excluded From Health Insurance

The insurance regulator seeks to reduce and standardise the number of health conditions and medical procedures excluded from health insurance policies.

The Insurance Regulatory and Development Authority of India, in an order uploaded on its website yesterday, said it has formed a working group to examine the issue. The panel—chaired by Suresh Mathur, executive director (health) at IRDAI, and comprising representatives of insurers—will submit its suggestions in eight weeks.

“We welcome a comprehensive review of exclusions as it would improve coverage for customers,” said Puneet Sahni, head of product development at SBI General Insurance Company. The insurers, he said, should be given the option to modify premium pricing based on the exclusions provided at the time of underwriting the business.

Most health insurance plans exclude pre-existing diseases, cosmetic and dental surgeries, pregnancy, vaccination, intentional injuries, HIV and alternative treatments such as homeopathy and ayurveda. In February this year, the Delhi High Court ruled that insurers can’t exclude genetic disorders and congenital anomalies, calling it a “violation of citizens’ right to health”.

The regulator now wants to standardise exclusions in health policies. The objectives of the group set up by it include:

  • Rationalise the exclusions by minimising the number to enhance the scope of health insurance coverage granted.
  • Remove exclusions that disallow coverage “with respect to new modalities of treatments and technologically advanced medical treatments”.
  • Study the scope of allowing exclusions specific to individuals and diseases at the time of underwriting business.
  • Provide a uniform framework for standalone health and general insurers to incorporate exclusions in their policies.
  • Standardise the language used by companies to list their exclusions.