The Insurance Regulatory and Development Authority of India (IRDAI) periodically revises the guidelines for health insurers to ensure better insurance coverage for all, including senior citizens. In its latest policy update, IRDAI revised its 2016 circular to omit the clause mandating insurers to offer policies to individuals up to 65 years of age, leaving the age criteria open.

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The updated rules took effect from April 1, 2024.

The previous circular was formulated to discourage insurers from rejecting policies to individuals, citing their higher age. It was mandatory for them not to decline proposals from people up to age 65 on age grounds.

However, insurers offering health plans to seniors older than 65 were not subject to regulatory constraints, and many insurers had already been offering them health policies. By removing the cap, IRDAI allows insurers to formulate their own products and policies catering to seniors.

One major concern for senior citizens’ health insurance has been the exorbitant premiums insurers traditionally charge due to their advanced age and health conditions. This makes access to health insurance coverage extremely difficult, if not completely out of bounds.

Here are some critical regulatory provisions benefiting policyholders, including seniors:

Pre-existing illnesses: IRDAI has modified its rules for pre-existing diseases. It has reduced the maximum waiting period from four to three years and the moratorium period for disputing claims from eight to five years.

Critical disease coverage: Health insurance companies can no longer refuse coverage to people having pre-existing medical conditions like cancer, heart or kidney failure, AIDS, etc.

Removal of age limit: Removing the age limit could encourage insurers to introduce more innovative products into the market, targeting different age groups, including senior citizens.

Policies for seniors: IRDAI has directed health insurers to formulate special policies that consider senior citizens and create a system to dispose of policy-related complaints quickly. It has also asked them to refine policies for maternity, students, and children.

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Policy premiums: As policy premiums are exorbitantly higher for senior citizens than others, insurers will allow policyholders to pay the insurance premiums in instalments.

No cap on AYUSH treatment: There is no cap on AYUSH treatment, such as Ayurveda, Yoga, Naturopathy, Unani, Siddha, and Homeopathy, with the option to get coverage for the entire insured sum.

Finally, insurers must develop innovative offerings to make health insurance affordable for senior citizens, where the potential product expansion remains endless.