Reduction in Exclusions Announced by IRDAI and Its Effect on Health Insurance Plans – Indian Money

Many people stay away from taking a health insurance plan because of the exclusions. But now IRDAI has taken a positive step to reduce exclusions, which is a positive sign that will help in bringing greater transparency into health insurance plans.

Indian Money CEO reveals how this reduction in exclusions holds a lot of promise for common people.

Health Insurance Exclusions

What are the common health insurance exclusions?

Common exclusions include:

  1. Pregnancy and associated expenditures such as on vaccination, child birth, and similar other costs do not get immediate coverage.
  2. Pre-existing diseases have a waiting period between two to four years prior to start of the coverage and includes diseases such as high blood pressure and diabetes.
  3. Alternative treatment techniques are not covered by some insurance providers. These treatments include homeopathy, Ayurveda, unani, etc.
  4. Surgeries such as dental, cosmetic, and joint replacement surgeries are not covered.
  5. Hospital expenditure consisting of ambulance fees, room rent, and doctor’s fees come with sub-limits.
  6. Permanent exclusions include HIV, injuries of war, congenital diseases, and intentional injuries.
  7. Diseases induced by lifestyle like smoking, drugs, drinking, etc. fall in this category.

According to IndianMoney company Bangalore, IRDAI (Insurance and Regulatory Development Authority of India) announced its decision about exclusions on 24th July 2018 which will greatly help in increasing penetration of health insurance in the country.

Let us now look at this review of exclusions in greater depth.

IndianMoney.com Review of Health Insurance Plan Exclusions

IRDAI has set up a 10 member committee which will look into these exclusions and suggest necessary changes. During its review, the committee will:

  1. Perform study to examine present exclusions so that these can be minimized.
  2. Identify exclusions that must continue.
  3. Make terminologies simpler for consumers to understand.
  4. Examine scope of ailment and individual specific exclusions (permanent) that are used during underwriting process. This will help in ensuring that someone’s claim is not denied due to a reason that is not related to exclusions.

 

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