The IRDAI has recently introduced some 5 major changes to health insurance regulations to make policies more customer-friendly. We should be aware of these most important 5 major health insurance policy changes in 2024.
These changes include reducing the waiting period from 4 years to 3 years, moving towards a fully cashless claim settlement system, and incorporating traditional treatments like Ayurveda, Yoga, Naturopathy, Unani, Siddha, and Homeopathy alongside mainstream allopathy.
Here are the 5 major health insurance policy changes to help you make decisions more effectively:
5 Major Health Insurance Policy Changes in 2024
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Most Awaited Health Insurance Policy Changes – Senior Citizen-Friendly Policies
No Age Limit for New Policies: One of the biggest changes is that anyone can now buy new health insurance policies, regardless of their age. Previously, individuals could only buy a new policy up to the age of 65.
Targeted Policies for Seniors: The IRDAI has also urged insurers to create specific policies tailored to senior citizens.
Dedicated Grievance Channels: Insurers must set up separate channels specifically to address the claims and grievances of senior citizens, making the process smoother for older clients.
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Claims Cannot Be Denied After 5 Years
Non-Contestable After 5 Years: Another significant change is that insurers cannot deny claims on the grounds of non-disclosure or misrepresentation after five years of the policy being in force.
Exception for Fraud: However, if insurers discover fraud, they can still contest the policy or claim in court even after five years.
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Discounts and Refunds
No-Claim Benefits: If policyholders don’t make any claims during the year, they can choose to either increase their sum insured or reduce their premium amount for the next year.
Pro-Rata Refund: Policyholders can now discontinue their policy at any time and receive a refund of the premium on a pro-rata basis. For example, if someone has paid Rs.12,000 for a year and decides to cancel after six months, they will get back Rs.6,000.
Refund on Claim Denial: Additionally, if an insurer denies a claim, policyholders can opt to discontinue their policy and get a partial refund based on the unused portion of the premium.
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Harder to Reject Claims
Claims Review Committee (CRC): Insurers now need to set up a Claims Review Committee to review any rejected claims.
Approval Needed for Rejection: Insurers can only reject claims after the committee’s approval, and they must provide specific reasons for rejection, referencing the relevant policy terms and conditions.
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Simplified Documentation Process
Direct Document Collection: Insurance companies or their Third-Party Administrators (TPAs) must collect necessary documents directly from hospitals, eliminating the need for policyholders to submit the same documents multiple times to make a claim.
Conclusion 
These health insurance policy changes by the IRDAI aim to make health insurance more customer-friendly. They bring significant benefits, especially for senior citizens, and enhance transparency and fairness in the claims process.
With more flexible options for refunds and discounts and an easier documentation process, these new regulations are set to improve the overall experience for policyholders.
Highlighting these major health insurance policy changes can help you effectively pitch health insurance policies to your clients, showing them how these changes improve trust and satisfaction with health insurance products.
