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Health insurance covers to get better, get ready for lesser exclusion


Topic starter

Every health insurance plan comes with a set of exclusions. These exclusions are illnesses and situations wherein your insurance provider can deny your claim. Now, though exclusions are common to every health insurance plan, they vary in number from one insurance company to the next. Even if the exclusions themselves are different, the terms and conditions applicable will be worded differently.

This can be confusing for customers.

Exclusions can be very confusing for customers. Some health insurance policies excluded some illnesses whereas others didn’t. This lack of standardization across insurance providers and insurance plans means that misconceptions were easily formed and customers were often left puzzled. This is especially since there are 25+ insurance companies in India today. Combined, they offer 400+ different insurance policies and each of them could have a different set of exclusions and related underwriting.

What are some of the common exclusions?

To begin with, most health insurance plans exclude illnesses contracted after taking the policy. Moreover, most plans deny a claim for injury or illness associated with hazardous jobs/activity. Psychological disorders and disorders arising from stress, puberty, genetics, and menopause, among many others, were excluded by most insurance providers.

But there’s good news!

The IRDAI has published a draft that attempts to standardize and reduce the number of exclusions of health insurance policies. Aside from including the illnesses mentioned in the paragraph above, the draft will also remove things like mental illnesses, Age-Related Muscular Degeneration, neuro-degenerative disorders, speech & language impediments, and dyslexia, from the list of exclusions.

 There’s more!

Besides for deflating the number of exclusions, the draft has also made it mandatory for every health insurance plan to cover modern procedures and treatments. Soon, insurance providers will have to ensure that their plans will cover things such as uterine artery embolization, deep brain stimulation, oral chemotherapy, and robotic surgeries, among many other modern treatments. Also part of the draft is writing that will include things like toothpaste, toilet paper, hand wash in the room cost.

On the other hand.

One must know that not all exclusions have been mitigated; there are few exclusions that will continue to exist. Moreover, to standardize things, the IRDAI has made 17 such exclusions permanent. These illnesses such as HIV, Parkinson’s, AIDs and epilepsy, among others, will be excluded by all health insurance plans.

What’s the cost?

Now, all good things come at a cost and so does this amazing announcement. After all, knocking of exclusions means increased costs for the insurance companies. To offset this, a rise in premiums is bound to come into the picture. However, one will only know how much the increased amount is after all the insurance stakeholders deliberate upon the same.

There is a moratorium period before which this draft will apply to every health insurance policy. Before it does, we suggest you speak to your health insurance provider for better clarity on the delisted exclusions and when they will be applicable to your policy. We hope this has been helpful, good luck and all the best!