HEALTH INSURANCE FOR SENIOR CITIZEN (Syllabus: GS Paper 2 – Health and Vulnerable Sections)

Context: The Insurance Regulatory and Development Authority of India (IRDAI), has lifted the age ceiling of 65 years on buying a new health insurance policy.

Insurance Regulatory and Development Authority of India (IRDAI)

• About: IRDAI is an autonomous and statutory body responsible for managing and regulating the insurance and reinsurance industry in India.
• Establishment: Under an Act of Parliament in 1999, IRDAI operates independently to oversee the functioning of insurers and protect the interests of policyholders.
• Headquarter: In Hyderabad.

Health Insurance for Senior Citizen

• Directive to Insurers: IRDAI has mandated insurers to create specialized insurance products catering to diverse demographics like seniors, students, children, and maternity.

o Insurers must design products tailored for specific groups to enhance inclusivity and accessibility.

• Previous Age Limit for Health Coverage: IRDAI had set a maximum age limit of 65 years for purchasing health insurance policies.

o Tougher Conditions: Beyond 65, stricter conditions applied, including mandatory health check-ups and exclusion of pre-existing ailments.

o Rationale: Age restriction was based on increased susceptibility to illnesses with age, impacting coverage options for those over 50.

• Coverage for Pre-Existing Medical Conditions: Insurers are obligated to cover individuals with pre-existing medical conditions like cancer, heart, or kidney failure, and AIDS.
• Renewal: IRDAI has prohibited insurers from refusing to renew policies based on ground that the insured had made one or more claims in the preceding policy years, 

o Except for policies that terminate after the payment of the benefit covered under the policy, such as a critical illness policy.

• Waiting Period: Health insurers cannot deny coverage for your pre-existing condition once you have completed the three-year waiting period on health insurance policies.