Insurance is a contract of indemnity based on the principle of utmost good faith which aims at mitigating the loss caused by an uncertain event such as life, health, fire, marine, etc. In India, the Insurance Regulatory and Development Authority (hereinafter referred to as "IRDA") regulates, promotes and ensures orderly growth of the insurance industry, protection of the policy holders and settlement of insurance claims.

Medical insurance facilities in India are one of the most vital insurance sectors which cover wellness and preventive hospitalization expenses and treatment costs for individuals. In a progressive approach, IRDA on September 30, 2019 has restricted the insurance companies from not including the illnesses from its cover, some of which are listed below:

  • Respiratory or skin ailments arising as a result of hazardous workplace conditions;
  • Age-related ailments such as cataract surgery, knee-cap replacements, Alzheimer's and Parkinson's.
  • Mental illness, stress, phycological, neurodegenerative disorders

The introduction of standardization of health norms would come as a breakthrough to bring clarity to the insured persons regarding the applicability of insurance in respect to their diseases/ ailments. Further, the health insurance policies would include pre-existing diseases disclosed by the insured persons immediately after the expiry of a waiting period for 48 months (the period which should elapse before the insured becomes entitled to health cover opted for by him/ her) or such lower period as may be stated in the insurance policy.

The pragmatic way forward brought about by IRDA would help millions of persons purchasing insurance to obtain the benefits of their policy thereby making the benefits of healthcare available to them.



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