Top Health Insurance Regulatory Changes In 2024 You Should Know About

Health insurance has always been a vital tool for safeguarding your finances against unforeseen medical expenses. But in 2024, the landscape of health insurance has evolved dramatically, bringing in a host of regulatory changes aimed at making coverage more inclusive, user-friendly, and beneficial for everyone. Here’s a deep dive into the key changes that could impact how you and your family approach health insurance this year.

1) No Entry Age Limits

For years, people have faced age-bar restrictions regarding health insurance purchases, particularly senior citizens. However, the year 2024 brought a landmark change when the Insurance Regulatory Development Authority of India (Irdai) ruled that policies, that were earlier capped at the entry age of 65, will now be available to individuals of all ages.

The insurers are now mandated to remove the 65-year age cap and offer health insurance policies to all individuals, basically senior and super-senior citizens. This shift means that whether you are buying a plan for yourself or an elderly relative, age is no longer a barrier.

What does it mean for you?

Senior citizens, who often face difficulties in getting health coverage for their needs, can now purchase a plan without age restriction. However, it should be noted that premiums are mostly high for plans that cater to senior citizens. 

2) Changes in the Waiting Period for PEDs

A significant update in 2024 came regarding the reduction in the waiting period for pre-existing diseases or conditions (PEDs). The waiting periods for PEDs have been cut from four years to three and this change has been made applicable across all types of health insurance policies.

What does this mean for you? 

Whether you are opting for family health insurance or a senior citizen-specific plan, quicker access to full coverage is now possible. 

3) Changes Regarding Cashless Claims

The cashless claim settlements have been a game changer for the insurance industry which brought much-needed relief for policyholders. This year two major updates were announced by Irdai on cashless claims, these were;

a) Cashless Everywhere

Gone are the days when cashless claims were limited to network hospitals. Under the updated guidelines of the General Insurance Council, policyholders can now avail of cashless claims at any hospital, irrespective of its network status.

What does it mean for you?

Imagine an emergency situation where you or a loved one is admitted to a hospital outside your insurer’s network. The hassle of upfront payments and later reimbursements has now been done away with. For users of family health insurance, this change is a game-changer, ensuring seamless care for everyone covered under the plan. Here’s what it enables;

1) For elective procedures, the customer should inform the insurance company at least 48 hours before the admission.

2) For emergency treatment, the customer should inform the insurance company within 48 hours of admission.

3) The claim should be admissible as per the terms of the policy and the cashless facility should be admissible as per the operating guidelines of the insurance company.

b) Faster Cashless Claim Settlements

Efficiency in claims processing has taken a leap forward in 2024. As per the new rules that took effect starting in 2024, admission-related claims now need to be processed within an hour, while cashless claim settlements at discharge must be completed within three hours.

What does it mean for you?

Faster claim settlements mean you can focus on recovery while insurers handle the financial aspects promptly. Families relying on health insurance to manage emergencies find this particularly reassuring in the hour of need.

4) Claim For Multiple Insurers

Not many policyholders might be aware of this change but now it is possible for an insured to file a claim or split claims across multiple insurers for a single hospitalisation.

For instance, if your hospital bill is Rs 14 lakh and you have two policies with coverage of Rs 7 lakh and Rs 8 lakh respectively, you can now combine them to cover the entire cost.

What does it mean for you?

This upgrade is particularly helpful for people who have both individual and family health insurance plans. It can ensure full financial coverage without out-of-pocket expenses. 

However, please note that you have to inform all your insurance providers about the health plans in your name. Moreover, when you file a claim, it must follow the Irdai rules.

5) Reduced Moratorium Period

In April 2024, Irdai had mandated that the moratorium period has to be reduced from eight to five years. This applies to all policies whether they are newly purchased, portable, or migrated.

The moratorium period refers to the period during which insurers could challenge your claims due to non-disclosure or misrepresentation.

What does it mean for you?

After maintaining a policy for five continuous years, you gain better protection against claim rejections. This development adds a layer of reliability, particularly for senior citizen health insurance.

6) AYUSH Treatment Coverage in Health Plans

AYUSH treatments, which include Ayurveda, Yoga, Unani, Siddha, and Homoeopathy, are now on par with conventional or allopathic medical treatments. The changes rule that insurers must offer comprehensive coverage for these alternative therapies up to the sum insured.

Moreover, Irdai also ordered the insurance companies to ensure their policies contain the quality parameters as well as the procedure for enrolling AYUSH Hospitals/Day Care Centers as network providers for the purpose of providing a cashless facility.

What does it mean for you?

Whether you prefer traditional treatment methods for yourself or an elderly family member, you can now claim expenses without worry under AYUSH treatments at any network hospital.

From removing age limits to enabling universal cashless claims and reducing waiting periods, these changes are very significant for policyholders. Take a round-up of these significant updates and keep these in mind as you enter 2025 and plan to purchase a health insurance plan or upgrade your existing one.