IRDAI regulations that have changed the face of health insurance industry in 2020

IRDAI regulations that have changed the face of health insurance industry in 2020

Regulations and modifications play an essential part in defining the growth and future of any industry and the insurance industry is no smaller. The Indian insurance enterprise – which is controlled by the Insurance Regulatory and Development Authority of India (IRDAI) – goes through plenty of changes and developments every year to make the insurance produce much more customer-centric. This helps customers take maximum advantage of their insurance outputs and they also start showing much more faith and confidence in insurance for financial well-being.

Talking about the wellness and health insurance industry appropriately, as it was the most superficial industry this year due to the ongoing COVID-19 pandemic, the industry went into a plethora of pennies to protect a maximum number of people in India. The changes and developments included were widely leveraged by the insurers to offer products that help customers better manage their health and stay adequately preserved.

Here’s a quick glimpse at the key changes in the health insurance industry in India in 2020.

Introduction of regular health product – Arogya Sanjeevani

In its wonderful effort to make quality healthcare in the reach of one and all, the IRDAI in its guidelines published on January 2nd January 2020 directed all common and specialized health insurers to start selling standard health insurance products – Arogya Sanjeevani Policy – from 1st April 2020. A vital reason for introducing a standard health insurance plan was that the contemporary health insurance products available in the market are a bit fixation for a common man to follow. The introduction of a standard health product has helped in getting the buying process much simpler and has played a significant role in developing strong faith and trust in customers towards the health security ecosystem.

Improvements in the health insurance industry due to the COVID-19 pandemic

Ever since the start of the COVID-19 pandemic in India in March, IRDAI has been consistently putting in extra efforts to handle the crises by a slew of projects to guarantee utmost convenience to the customers.

The first and leading expansion that happened in the insurance space following the pandemic was the extension of treatment for COVID-19 under health insurance policies. Usually, pandemics are not employed under health and life insurance policies. This was a delightful move as a treatment for COVID-19 amounts to around Rs 2 lakh – Rs 4 lakh for 14-day hospitalization. With the pandemic being held under health insurance, people could take the feature way without worrying about the cost.

Further, some variations were even performed in the underwriting rules for issuing health insurance policies to the customers. Keeping in mind the nation-wide lockdown, the director directed all insurers to issue health insurance plans to customers within telemedical anywhere possible if conducting a mandatory physical medical test was not viable. The government even provided the use of e-KYC for restoration or issuing of new policies to the customers.

Under another set of guidelines, customers were entitled to approve issuing a health policy for video KYC or OTP in place of changing signatures. This helped characters stay at home and regard social distancing rules and yet get a plan issued for economic well-being.

In July, in the direction of the IRDAI, insurers came out with COVID-19 particular health coverage policies named – Corona Kavach and Corona Rakshak. Both these fitness coverage procedures were introduced to provide financial security to frames falling under the lower income-group so that they can avail the most beneficial potential treatment for COVID-19.

Within a few months after the results were launched, over 3 million policies were purchased by consumers to stay financially secure. These products increased the trust and faith amongst customers in insurance products up to a great degree, all thanks to the excellent pricing of these outcomes.

In September, the governor even allowed covering treatment through telemedicine under a health insurance plan. Telemedicine will be a boon for people staying in Tier 2 and 3 cities as they will not have to travel to Tier 1 cities for doctor’s discussion and can rather discuss their situation with a doctor from the comfort of their homes and get the charges related under OPD expenses through health insurance.

Standardization of health insurance policies

Effective 1st October 2020, revised health insurance policies were introduced which allowed wider coverage to the customers. For the customers, the updated policies will mean cover for more illnesses and procedures at affordable rates. The plans will now offer coverage for many new ailments such as mental disease, age-related degeneration, internal congenital conditions, and artificial life maintenance.

Some other popular attacks for which cover will be given under your insurance plan include behavior and neurodevelopment diseases, genetic diseases and disorders, and cover for adolescence and menopause-related sickness.

Also, the definition of Pre-existing Conditions (PED) has been adjusted to cater to the needs and requirements of customers. As per the new guidelines, any disease/s or disease/s that is/are diagnosed by a physician 48 months before the issuance of the shaped cover will be classified under PED. To ensure that policyholders experiencing pre-existing diseases get enough health insurance coverage, IRDAI has mandated the insurers to include strong exclusions only after the due consent of the customers.

Moreover, going forward, insurers cannot refuse a claim requested by a policyholder after the insured has paid the award for the policy for 8 consecutive years. This means a customer’s wellness insurance claim won’t be rejected from the 9th policy year saving you have indulged in fraud or are making a claim for a strong exclusion.

These new revisions in the current laws around health insurance are believed to benefit the customers to a great amount. The revisions are set to make the coverage way more thorough and efficient for the policyholders.

Induction of EMI option for premium payment

Amidst the continuing COVID-19 outbreak, the IRDAI has come out including a qualification permitting customers to pay their health insurance rebates in installments. The premium model (repetition) can be monthly, quarterly, or half-yearly as determined by the insurer. The modification will play a significant part in improving affordability in health insurance production.


With all these commands in place, the future looks encouraging for the health insurance industry with several alterations in the regulatory framework which will lead to a wave of innovation in the way the industry conducts its business and contracts with its customers. Also, several demographic factors such as the growing middle class, increasing insurable population, and growing appreciation for the need for adequate protection will support the growth of health insurance.

With the new adjustments in place, the health insurance perception which today stands at 4 percent only is anticipated to grow and expand in India.