IRDAI panel suggests excluding 17 ailments from medical cover – The Hindu Business Line – 4th November 2018

In what could be a significant benefit for customers, a panel set up by the insurance regulator has
recommended a standardised list of just 17 pre-existing diseases that could be excluded from health
insurance policies.
Further, diseases such as Alzheimer’s, Parkinson’s, AIDS/HIV infection, morbid obesity, if contracted after
buying a health cover, cannot be excluded.
The standardised list of 17 permanent exclusions include epilepsy, congenital heart disease, cerebral
stroke, chronic liver and kidney diseases, hepatitis B, Alzheimer’s, Parkinson’s, HIV and AIDS, loss of
hearing, and physical disabilities.
“The proposer’s consent is mandatory so that the proposer may take an informed decision,” said the
report of the working group set up by the Insurance Regulatory and Development Authority of India
(IRDAI), which has also given the exact classification, or ICD code, to ensure there is no scope for
“subjective interpretation” by insurers at the time of claim settlement.
Waiting period
The working group has also suggested a four-year waiting period for inclusion of any ailment in the
health cover against the current average two-year waiting period.
However, for conditions such as hypertension, diabetes and cardiac problems, the committee has said
that the waiting period should not be more than 30 days. “It is viewed that the clauses are open-ended
and not specific,” the report observed.
To ensure that people with serious pre-existing diseases, including those with disabilities, can get health
insurance, the committee has also suggested that insurers can include permanent exclusions with due
consent of the proposer or customer.
“This could mean that people such as cancer survivors, who find it extremely difficult to get health cover,
may now be able to get policies with exclusion for such conditions,” said an insurance company
executive.
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Significantly, in keeping with medical advances, the panel has also said that new treatments such as
balloon sinuplasty, deep brain stimulation, oral chemotherapy, immunotherapy, robotic surgeries, and
stem cell therapy may be included in health covers.
IRDAI is likely to come out with its final report by early next year and the benefits could kick in from
2019-20.

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