Exclusions in health policies: IRDAI panel to submit report by year-end – The Hindu Business Line – 17th October 2018

A committee set up by the Insurance Regulatory and Development Authority of India (IRDAI), the
insurance regulator, to standardise exclusions in health insurance policies, is likely to submit its report in
the next two months, recommending that health policies should also be available to people with longstanding,
non-curable but manageable diseases.
Sources close to the development said that persons with diseases, including hemophilia, certain autoimmune
diseases, cardiac problems and diabetes, may now find it easier to get health cover.
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“The general idea is that even if a person is suffering from such diseases but is receiving treatment and
has declared it, he or she should be able to get health cover if not fully for that particular disease, but then
for any other health problem that may arise later,” said the source.
The committee will take another two to three months to finalise its recommendations, he added. Another
issue under discussion is how and in what form cancer survivors could get health insurance. “At present,
it is very difficult for persons who have successfully recovered from cancer to get health cover even if
they declare it,” and this issue will also be looked at by the committee.
Sources said the committee is also likely to provide clarity on the definition of mental illnesses, which
now have to be mandatorily covered under health insurance. However, the premium and pricing of
medical insurance policies are also likely to be impacted with the changes.
The IRDAI had, in July this year, set up a working group to rationalise the exclusions in health insurance
policies to enhance the scope of health insurance coverage.
Significantly, the committee led by Suresh Mathur, Executive Director (Health), IRDAI, has also been
asked to rationalise the exclusions that disallow coverage with respect to new modalities of treatments
and technologically-advanced medical treatments.
“With the increase in the number of companies providing health insurance, there is an increase in the
number of products offered. It is desired that the industry adopts a uniform approach,” the IRDAI had
noted.

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