The regulator, in a press note issued on January 30, 2025, said that the insurance companies should consult with it before:
1. If the increase proposed is more than 10% per annum.
2. In case of withdrawal of individual health insurance products offered to senior citizens.
The most vulnerable age group is senior citizens with limited sources of income, and this group is impacted the most when there is a steep increase in health insurance premiums. This matter has been engaging the attention of Irdai and is a regulatory concern.
This ensures transparency and prevents abrupt changes that could leave seniors without necessary coverage. It added that the premium rate is primarily based on the estimated claims outgo and the expenses including acquisition costs incurred by the insurance company for acquiring and servicing the insurance policies. The claim outgo is largely dependent on the amounts charged by the hospitals for various treatments/surgeries.
Moreover, Irdai has instructed insurance firms to facilitate the joint empanelment of hospitals and establish negotiated package rates similar to those of the Pradhan Mantri Jan Arogya Yojana (PMJAY) scheme.
Unlike the Pradhan Mantri Jan Arogya Yojana scheme where the hospitalization expenses are negotiated centrally for package rates and are thus standardized across hospitals. There is no such thing in case of health insurance products. This is leading to higher hospitalization costs resulting in higher claims outgo under health insurance products offered by insurers.
IRDAI said the regulatory framework mandates that all insurers create a dedicated channel to handle health insurance claims and grievances for senior citizens. This information must be readily available on the insurer's website for easy access.
In April 2024, the IRDAI eliminated the age limit of 65 years for individuals looking to purchase health insurance policies. They directed insurance companies to provide health insurance options to individuals of all age groups. Furthermore, the waiting period for pre-existing conditions was decreased from four to three years. These regulations have been in effect since April 1, 2024.
This ensures transparency and prevents abrupt changes that could leave seniors without necessary coverage. It added that the premium rate is primarily based on the estimated claims outgo and the expenses including acquisition costs incurred by the insurance company for acquiring and servicing the insurance policies. The claim outgo is largely dependent on the amounts charged by the hospitals for various treatments/surgeries.
Moreover, Irdai has instructed insurance firms to facilitate the joint empanelment of hospitals and establish negotiated package rates similar to those of the Pradhan Mantri Jan Arogya Yojana (PMJAY) scheme.
Unlike the Pradhan Mantri Jan Arogya Yojana scheme where the hospitalization expenses are negotiated centrally for package rates and are thus standardized across hospitals. There is no such thing in case of health insurance products. This is leading to higher hospitalization costs resulting in higher claims outgo under health insurance products offered by insurers.
IRDAI said the regulatory framework mandates that all insurers create a dedicated channel to handle health insurance claims and grievances for senior citizens. This information must be readily available on the insurer's website for easy access.
In April 2024, the IRDAI eliminated the age limit of 65 years for individuals looking to purchase health insurance policies. They directed insurance companies to provide health insurance options to individuals of all age groups. Furthermore, the waiting period for pre-existing conditions was decreased from four to three years. These regulations have been in effect since April 1, 2024.
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