IRDAI Decides to Enhance the Scope of Health Insurance Coverage

The Insurance Regulatory Development Authority in India wants to enhance the scope of health insurance coverage. All the health insurance policyholders may soon get the coverage and benefits for certain ailments/diseases and medical procedures that were earlier excluded. IRDAI has sought standardization of ‘exclusions’ in medical insurance policies and regularity in wording the exclusions by insurers and has set up a working group to make approvals on exclusions. Since more comprehensive insurance products are being introduced, the number of exclusions by insurance companies is also growing. IRDAI wants to minimize this exclusion list as this make a big fat confusion among the customers.

Different medical insurance products hold different type of exclusions and the same omission could mean different things and it creates distress and distrust. The rejection of a claim or inexcusable deduction of expenses from the customer perception generally stops from exclusions. With the growing number of insurance firms there are also increasing numbers of health insurance products. But IRDAI wants that insurance industry adopt a consistent approach while incorporating the ‘exclusions’ as part of product design as well as for wording of ‘exclusions’. The working group which has been set by IRDAI will reduce exclusions by minimizing the number to enhance the scope of health insurance coverage. It will also decrease exclusions that prohibit coverage with respect to new procedures of treatments and technologically advanced treatments. The group will study the wordings of the exclusions and standardize them for making it simple and easily understandable.

According to Prawal Kalita, director at JLT Independent Insurance Brokers, The recent IRDAI wants to form a committee to downsize the number of exclusions in health insurance and to ensure uniform wordings on exclusions which helps to increase positive development. At present there is lack of normal exclusion list as most of the insurance firms have filed the products with their own list of exclusions. This method leads to enlarge confusion among the customers while choosing a health insurance product. Nowadays the people becoming more tech-savvy and purchasing insurance policies online and a standard list of exclusions will be helpful for them while buying a mediclaim policy.

One of the main aims of this step is to enhance the scope of health insurance coverage for the policyholders. In the past, IRDAI has also taken the steps to standardize health insurance and to enhance simplicity and uniformity in the policy documents.

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