Evolution of Health Insurance in India: 7 Notable Changes Over the Past Year

Do you know about the major changes in health insurance in India over the past year? These updates have been driven by new rules from IRDAI (Insurance Regulatory and Development Authority of India). The goal behind these reforms is to make health insurance more transparent and customer-friendly.

7 Major Changes in India’s Health Insurance

Understand these notable changes over the past year to learn how health insurance has evolved and how you can benefit from it.

1. Waiting Period Has Been Reduced for Pre-Existing Conditions

Earlier, people had to wait for four years before they could make claims for pre-existing diseases (PEDs) such as diabetes, thyroid, or hypertension. Now, this waiting period has been reduced to three years.

This means that if you purchase health insurance coverage for three continuous years, your insurer cannot deny claims for pre-existing illnesses. Claims can only be denied if there is a case where fraud has been committed or some fact has been intentionally misrepresented. This is great news for people who have chronic health conditions, as they can access coverage and benefit from cashless treatment sooner.

2. Moratorium Period Has Been Shortened

The moratorium period is the time during which an insurance company can review your policy and question or reject a claim. Earlier, this period was 8 years but now it has been reduced to 5 years. So, suppose for five continuous years, you have paid your premium and kept the health insurance policy active, your insurer will not be able to reject your claim even if they later find some errors or missing details in your old application. The exception is in cases of fraud.

The implication of this change is that after holding a policy for five years, your claims become fully protected and unquestionable. Thus, long-term customers are protected from disputes and genuine claims can be settled quickly.

3. Lifetime Renewability

Lifetime renewability is beneficial to senior citizens; it means senior citizens can continue their health insurance coverage without facing any sudden rejection or cancellation of their policy. Thus, there is no upper age limit for renewing health insurance.

Also, in case your insurer increases the premium amount above 10%, they should explain in writing. And they cannot deny renewal of policy or porting. This change is set to protect elderly policyholders and ensure they are treated fairly.

Also Read: Lifelong Renewability of Health Insurance

4. Annual Premium Hikes for Seniors Have Been Capped

As discussed earlier, IRDAI has introduced a cap of 10% per year on premium hikes. And if your insurer wants to increase the premium by more than 10% for any reason, they must get approval from the regulator first. The cap helps in providing financial predictability and helps in budgeting. Also, senior citizens will remain protected from rising healthcare costs.

5. Claims Review Committees Need to Be Set Up

Insurance companies are now required to set up Claims Review Committees. IRDAI has stated that any claim rejection must go through this committee and a clear explanation needs to be provided in case of rejection.

Also, if your hospital bill exceeds the limit of one policy, you can use another policy to cover the remaining amount. This means you can use multiple health insurance policies to settle a single claim.

6. Inclusion of AYUSH and Modern Treatments

New changes have also mentioned that health insurance policies must now cover AYUSH treatments (Ayurveda, Yoga, Unani, Siddha, and Homeopathy) without any sub-limits up to the total sum insured.

At the same time, insurers are also including modern and advanced treatments, such as robotic surgeries, oral chemotherapy, immunotherapy, stem cell therapy, and deep brain stimulation.

Thus, modern and AYUSH treatments are being included in health policies and people can access both traditional and advanced medical care as per their needs.

7. Digital Claims Exchange and Control on Treatment Costs

Are you aware of this update, where India launched the National Health Claims Exchange (NHCX), which is a digital platform that allows hospitals, insurers, and patients to process claims in real time. It was launched in June 2024 and it helps to settle claims faster and the entire process is less dependent on paperwork.

Also, the government and IRDAI have moved to bring NHCX under tighter scrutiny to curb inflated hospital bills and standardise rates. This has been done to control the increase in insurance premiums and make health insurance and healthcare more affordable.

Also Read: Maternity Leave in India 2025 : Rules, Importance & Benefits

Understanding the Impact of These Changes on Policyholders

These new rules have made health insurance in India simpler and more customer-friendly.

●       You will be able to make claims for long-term illnesses like diabetes or heart disease sooner because the waiting period for pre-existing diseases has been reduced to three years.

●       The cap on yearly premium hikes ensures that senior citizens do not face sudden increases in their health insurance costs.

●       Policyholders can now use two or more health insurance plans to settle a single hospital bill. This means you don’t lose out on benefits if one policy has a lower limit.

●       Health plans now include both AYUSH treatments and modern treatments; thus it gives more medical options.

●       With the launch of the National Health Claims Exchange (NHCX), claim processing has become quicker and more transparent and it reduces paperwork and confusion.

●       The creation of claims review committees ensures that if a claim is rejected, it must have a valid reason. This reduces unfair denials.

Final Words

The notable changes in health insurance will benefit policyholders to a great extent. It will also increase trust among insurers and insured. Also, many insurance companies are also using AI-based tools and digital platforms to process claims faster and with fewer errors. This means customers can expect smoother experiences and quicker settlements in the future.

If you want to explore medical insurance for family or medical insurance for senior citizen, visit Bajaj General Insurance and stay protected, stay insured.

FAQs

1. What is the new waiting period for pre-existing conditions under health insurance in India?

The waiting period has been reduced from four years to three years for pre-existing diseases across all indemnity-based health policies. After this, claims cannot be denied for non-disclosure except in cases of fraud.

2. Can senior citizens buy health insurance without age limits in India?

Yes. IRDAI mandates lifetime renewability with no upper age limit. Insurers must transparently justify any rejections or premium hikes beyond 10% annually for senior citizens.

3. Is there a cap on how much premium can increase year-on-year?

Yes, for policyholders aged 60 and above, the annual premium hike is capped at 10% without prior IRDAI approval. Anything above that needs regulator consent.

4. Can I claim expenses under multiple insurance policies for the same hospitalisation?

Yes. IRDAI now allows combining claims across multiple insurers, as long as all insurers and sum insureds are disclosed, and each policy permits benefit-based claims under its terms.

5. Are AYUSH treatments covered under standard health insurance plans?

Yes. AYUSH treatments such as Ayurveda, Yoga, Unani, Siddha, and Homeopathy are now covered without sub-limits, up to the policy’s sum insured.

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***Disclaimer: The content on this page is generic and shared only for informational and explanatory purposes. It is based on several secondary sources on the internet and is subject to changes. Please consult an expert before making any related decisions.