Context

The Insurance Regulatory and Development Authority of India (IRDAI) has relaxed the restriction on applying for health insurance in India that allowed only individuals aged 65 and lower to purchase health covers. 

No Age Limit To Purchase Health Insurance

• Expansion of Insurance Coverage: The recent development has pushed insurance companies to provide insurance to people irrespective of their age.
  • Previously, individuals could only buy new policies until age 65, but as of April 1, this limitation has been removed, allowing people of any age to obtain coverage.
  • This would promote inclusivity and accessibility in healthcare. 

What is Health Insurance?

• Health insurance is an insurance product which covers medical and surgical expenses of an insured individual in return for payment of a monthly premium.

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Updated Regulations for Health Insurance:

• Inclusive Health Insurance Mandate: IRDAI  has mandated all insurers to offer health insurance products catering to all age groups, including seniors, students, children, and maternity needs. 
  • Insurers must provide coverage to individuals with pre-existing medical conditions, such as cancer or heart failure, without refusal.
• Premium Payment: Insurers are required to offer premium payment in installments for policyholder convenience, and travel policies can only be provided by general and health insurers. 
• Non-Restricted Coverage for AYUSH Treatment: There is no cap on coverage for AYUSH treatments, including Ayurveda, Yoga, Naturopathy, Unani, Siddha, and Homeopathy.
• Flexibility in Claim Filing: Policyholders with benefit-based policies are permitted to file multiple claims with different insurers, offering greater flexibility. 
• Specialized Channel for Senior Citizen Complaints and Claims: A specialized channel to address complaints and claims from senior citizens, ensuring a tailored and responsive approach to their needs.

Insurance Regulatory and Development Authority of India (IRDAI)

• Established: It is a statutory body formed under an Act of Parliament, i.e., the Insurance Regulatory and Development Authority Act, 1999.
• Role: It is an autonomous body and regulates and supervises the development of  the Insurance sector in India.
• Functions: To protect the interests of the policyholders in matters concerning the assigning of policy, nomination by policyholders, insurable interest, settlement of insurance claim, surrender value of the policy and other terms and conditions of contracts of insurance

Government Initiatives

• Bima Sugam Portal: It is an online marketplace that will house all companies selling life and non-life insurance on a single platform.
• Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY): It provides a defined benefit cover of Rs. 5 lakh per family per year. 
• Rashtriya Swasthya Bima Yojana (RSBY): The scheme provides coverage of up to  ₹30,000 per family annually for hospitalisation expenses, including pre and post-hospitalisation expenses.

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