New IRDAI Health Insurance Guidelines in 2026

Health insurance in India just got a major upgrade! In 2026, the Insurance Regulatory and Development Authority of India (IRDAI) rolled out a series of new guidelines designed to make health insurance more accessible, inclusive, and transparent for every policyholder.

From ensuring coverage for severe illnesses like cancer and stroke to reducing waiting periods for pre-existing conditions, these reforms mark a big shift toward consumer-friendly healthcare protection.

Before you buy or renew your policy, here’s everything you need to know about the new IRDAI health insurance guidelines and how they benefit you.

List of The Latest IRDAI Health Insurance Guidelines in 2026

Removal of the Age Barrier in Health Insurance

Previously, many health insurance policies had an age limit as an eligibility criterion. This restriction mainly excluded older people aged 60 or 65 from getting that insurance coverage. IRDAI recently removed the age restriction on buying health insurance policies.

Impact on Policyholders: This IRDAI guideline will open multiple options in health insurance for older people aged 60 to 65.

Reduction in The Waiting Period for People With Pre-Existing Conditions

Waiting period in health insurance is a specific time that you have to wait after buying a policy before you can raise a claim regarding a pre-existing condition. Earlier, most insurance companies had a waiting period of 4 years as per their policy for people with pre-existing conditions.

However, IRDAI’s recent guideline changed the waiting period to 36 months or 3 years.

Impact on Policyholders: This will improve the accessibility of financial support for people who are looking for treatment of long-standing health issues.

Reduction in Waiting Period for People with Specific Diseases

Insurance companies offer health insurance policies with a conditional waiting period on specific diseases, like knee replacement surgeries. IRDAI's recent guideline says that insurers can set a waiting period of a maximum of 3 years for such claims.

This means people who have had a health insurance policy for 3+ years are eligible to raise a claim for knee replacement surgeries.

Impact on Policyholders: Problems like arthritis do not require emergency help. However, they are very hard to live with. This guideline will help people suffering from problems like arthritis get their surgery sooner.

Including Severe Medical Conditions

IRDAI recently launched its Non-discrimination policy. As per this policy, insurers can no longer deny claims to people suffering from severe medical conditions such as cancer, strokes, renal failure, AIDS, and more.

Moreover, it is now mandatory for health insurance providers to include coverage for such diseases.

Impact for Policyholders: This will help people suffering from a major health crisis to get special healthcare. It also relieves them from the financial strain and focuses on being healthy again.

Ensures AYUSH Treatments Up To Sum Insured

Previously, many insurers imposed sub-limits on AYUSH (Ayurveda, Yoga, Naturopathy, Unani, Siddha, and Homoeopathy) treatments. Which means you can only claim a part of your sum insured when receiving AYUSH treatments.

IRDAI’s recent guideline removed this capping, and people can now claim up to the full sum insured value for their AYUSH treatments.

Impact for Policyholders: This will help people who prefer AYUSH treatments over modern medicine to get equal health insurance benefits.

Reduced Moratorium Period in Health Insurance

The moratorium period is a set timeframe after which an insurer can no longer deny claims based on non-disclosure or misrepresentation of pre-existing diseases unless they prove it to be a fraud case. Previously, insurance companies had a long moratorium period in their policy terms.

However, the new IRDAI Health Insurance Guidelines in 2026 capped the moratorium period to a maximum of 5 years.

Impact for Policyholders: This will help people who had no idea of their hidden pre-existing conditions to gain financial support for their medical treatments.

Inclusion of Benefit-Based Policies

Previously, insurers used indemnity-based policies to provide claims, where they would provide the actual expense of the medical treatment after analysing the total bills. However, IRDAI has now introduced the benefit-based insurance policies.

As per this policy, the insured will get a fixed sum of money right after the diagnosis of a disease.

Impact for Policyholders: Introduction of this policy will remove the hassle of providing all the medical bills to the insurer, and policyholders can enjoy the flexibility to use the claim amount as per their needs.

Inclusion of Telemedicine in Health Insurance

During the COVID-19 outbreak, people had to get remote medical consultations online. These costs for such treatments could add up to a huge amount, which is a loss for the insured. Hence, IRDAI made it mandatory for health insurance companies to include telemedicine in the coverage.

Impact for Policyholders: This will help people to freely access medical consultations online in case there is a lockdown in the future.

Possibility of Multiple Claims Across Various Insurers

As per the new IRDAI health insurance guidelines, people who have a benefit-based insurance policy can now file claims across multiple insurers.

Impact for Policyholders: This new IRDAI health insurance guideline will offer more flexibility and a greater chance for people to receive financial help during a health crisis.

 Approval of Cashless Claims

Many insurance companies offer cashless hospitalisations in case of emergencies. However, there was no set time within which they must pay the hospital. However, as per the latest IRDAI guidelines for health insurance, insurers must authorise the payment within 3 hours of receiving bills at the time of discharge.

Impact for Policyholders: This will make health insurance more convenient for people as it decreases the wait time after discharge.

Guidelines on the Network of Cashless Hospitals

As per the new IRDAI health insurance guidelines in 2026, insurers must maintain a list of their network hospitals where they will provide cashless services. They must also provide clear guidelines on their reimbursement policy for services consumed outside their network.

Impact for Policyholders: This new guideline will help increase transparency between the insurer and the policyholder. Moreover, people can also analyse the network of a particular policyholder before buying health insurance policies from them.

How do you know that your insurer follows all the IRDAI guidelines? Well, you can choose Bajaj General Insurance to ensure you get all the benefits that IRDAI wants the people of India to have. Click here to know more about the Bajaj Health Insurance plans and prices.

How to Choose a Health Insurance Plan After the New IRDAI Guidelines?

Insurance companies generally provide health insurance plans based on indemnity plans and benefit-based plans. You can choose either one of them based on your needs. However, currently, people with benefit-based health insurance plans have the option to file multiple claims with several insurers.

Hence, people who can afford multiple health insurance policies for themselves must opt for benefit-based health insurance plans.

Things to Consider While Purchasing Health Insurance In India (After IRDAI Guidelines)

Buying a health insurance plan can be very economical when you choose your health plan smartly. Read more to know how to smartly purchase your health plan.

Choose a High Sum Insured

Both benefit-based insurance plans and indemnity-based insurance plans provide a claim only up to your sum insured. Hence, having a high sum insured will provide better protection.

Check Your Insurer’s Network of Hospitals

Your insurance company must have a large network of hospitals. This will get you emergency help near your location at your convenience.

Thoroughly read the Terms and Conditions Before Buying

Always read through the terms and conditions of your insurance policy before buying an insurance policy.

Check Your Insurer’s CSR

You can check your insurance company’s trustworthiness by looking at its previous year’s Claim Settlement Ratio (CSR). Choose an insurer with high CSR.

The Bottom Line

The new IRDAI Health Insurance Guidelines were published with the sole purpose of making health insurance more beneficial, transparent, and accessible for the people of India. Apart from these, another major change in the health insurance sector is the reduction of GST on health insurance from 18% to 0%.

All these changes indicate that now is the best time to buy a health insurance policy. Click here to know about the current prices of health insurance policies in India.

Frequently Asked Questions

Is now a good time to buy health Insurance in India after the new IRDAI health insurance guidelines in 2026?

Yes, the IRDAI has made significant changes in the health insurance sector in 2026, with the main objective to make health insurance more transparent and accessible to the policyholders. Moreover, since the launch of GST 2.0, tax on health insurance has been reduced to 0%, which will help make it more affordable.

What are the IRDAI guidelines for health insurance portability in 2026?

As per the new IRDAI rules for health insurance, policyholders can now switch to a new health insurance plan with a different insurer without losing accumulated benefits, such as waiting periods for pre-existing conditions. However, you can only do it at the time of insurance renewal, and you must disclose this to your insurer at least 45 days before your renewal.

Are there any changes in the claim settlement process under the new IRDAI guidelines?

Yes, the IRDAI has introduced major reforms in 2026 to make health insurance claims faster and more transparent. The moratorium period is now capped at five years, and benefit-based policies have been included for easier claim payouts. Insurers must approve cashless claims within three hours of discharge, and policyholders can now make multiple claims across different insurers, ensuring greater flexibility and convenience.

How do the latest IRDAI guidelines impact the cost of health insurance premiums?

Currently, IRDAI puts a limit on the hike in health insurance premiums for senior citizens to a maximum of 10% without prior approval. Moreover, in future, the hike in prices for common policyholders may be directly linked with the hike in healthcare prices. On the other hand, many IRDAI guidelines, like reduction in the waiting periods, increase the risk and may cause a hike in prices.

What does the reduced moratorium period mean for policyholders?

The moratorium period is the time period after which insurers can no longer deny claims based on grounds of non-disclosure or misinterpretation of pre-existing diseases. A reduced moratorium period will make it easier for people with pre-existing diseases to raise and get claims.

What are the latest IRDAI guidelines on AYUSH treatments?

Previously, many insurers would set sub-limits on AYUSH treatments. Which means people could only claim up to a limit of their sum insured for AYUSH treatments. IRDAI removed the SUB-limit policy, making insurance fully accessible for people who prefer AYUSH treatments over modern medicine.

Do the new IRDAI guidelines apply to all health insurance providers across India?

Yes, the new IRDAI health insurance guidelines in 2026 apply to all general and health insurance providers across India. This includes offering a mandatory COVID-19 standard health insurance policy.

How do these guidelines affect the availability of customised health insurance plans?

The new IRDAI health insurance guidelines in 2026, in many ways, help with the availability of customised plans. For example, IRDAI removed the age barrier on health insurance, which opens multiple options for older people between 60 and 65 years of age. Moreover, IRDAI also included telemedicine and severe diseases as a part of coverage, which enhanced health insurance for policyholders.

*Standard T&C apply Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms, and conditions, please read the sales brochure/policy wording carefully before concluding a sale.