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

News-CRUX-10     29th April 2024        

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.

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