As per the earlier guidelines, individuals were allowed to purchase a new insurance policy only till the age of 65
To widen the market and foster adequate protection from healthcare expenses, insurance regulator IRDAI has removed the age limit of 65 years for individuals buying health insurance policies.
This marks a significant departure from the conventional constraints that limited individuals in securing comprehensive coverage.
By abolishing the maximum age restriction on purchasing health insurance plans, the Insurance Regulatory and Development Authority of India (IRDAI) aims to foster a more inclusive and accessible healthcare ecosystem, ensuring adequate protection against unforeseen medical expenses.
As per the earlier guidelines, individuals were allowed to purchase a new insurance policy only till the age of 65. However, with the recent amendment, which has been effective from April 1, anyone, regardless of age, is eligible to buy a new health insurance policy.
In a recent gazette notification, IRDAI said, “insurers shall ensure that they offer health insurance products to cater to all age groups. Insurers may design products specifically for senior citizens, students, children, maternity, and any other group as specified by the Competent Authority.” Besides, insurers have been mandated to offer health policies to individuals with pre-existing medical conditions of any kind.
Consequently, insurers are prohibited from refusing to issue policies to individuals with severe medical conditions like cancer, heart or renal failure, and AIDS.
According to the notification, insurers are allowed to offer premium payment in instalments for the convenience of policyholders.
Travel policies can only be offered by general and health insurers, it said.
There is no limit on AYUSH treatment coverage. Treatments under systems like Ayurveda, Yoga, Naturopathy, Unani, Siddha, and Homeopathy will receive coverage up to the sum insured without any cap, it said.
Policyholders with benefit-based policies can file multiple claims with various insurers, enhancing flexibility and options, it said.
The proposed regulation seeks to handle the complaints and claims of senior citizens via a specialised channel, ensuring a more tailored and responsive approach to their requirements, it added.
Expert views on the same:
“The new set of revisions by the IRDAI are well revered and are significant enablers that will empower one of the most sensitive demographics to secure them against major health concerns. Earlier, this age group at a massive level was not able to avail of treatment benefits from advanced healthcare facilities owing to multiple reasons, the primary concern being unaffordability. With the new reform, this problem has been eradicated from the ecosystem, marking a historic landmark in the confluence of the healthcare and insurance industry.
Along with this, other key developments include the reduction of the waiting period from 48 months to 36 months, and coverage of all pre-existing health conditions after the waiting period among other benefits in the sheer interest of the end-consumers. Overall, these revisions will bolster the move to promote a healthy and secure living across the country.”
–Dr Manisha Karmarkar, CEO, DPU Super Specialty Hospital, Pimpri, Pune
“Its welcome move by the Regulator to remove the entry age barrier of 65 yrs for purchasing the Health Insurance Cover. Although having said that it would be left to the Insurers to design the products which is suitable to this age group. Eg: the new product should certainly cut down on the waiting period for pre-exiting disease or a graded claim pay out should happen in first three years and full claim post 4 yrs. of continuous renewal. The Senior Citizen Health Insurance market is quite huge either having no coverage or poor coverage in terms of smaller sum insured which is not enough to foot the current hospital bills. This is a great opportunity to innovate and penetrate the underserved market.”
–Sumit Bohra, President of Insurance Brokers Association of India (IBAI)
“IRDAI’s decision to remove age restrictions for entry into health insurance policies is indeed a step towards inclusivity in the insurance sector. However, it’s essential to acknowledge that insurers may not be enthusiastic about catering to the 65+ age bracket. Even if they do, the terms and conditions of such policies may not be entirely favourable to the customer. For instance, while a 70-year-old individual may now have the opportunity to purchase health insurance for the first time, they will likely encounter stringent terms, exclusions, and possibly high premiums. It’s a reality that the 65+ age group often comes with pre-existing conditions, prompting insurers to carefully evaluate the profitability, sustainability, and scalability of policies for this demographic. In light of these considerations, individuals seeking health insurance post-retirement may find it advantageous to continue with employer-offered health insurance, where insurers can provide more competitive premium rates and favorable policy conditions. Ultimately, while IRDAI’s move promotes access to insurance for older age groups, it also underscores the importance of aligning insurer interests with customer needs to ensure comprehensive and equitable coverage across all demographics.”
-Anuj Parekh, Cofounder and CEO, Bharatsure
Edits by Express Healthcare