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Health Insurance Regulations Every Policyholder Should Know

Published On Feb 15, 2022

When a health emergency occurs, a person's health becomes a concern. In terms of enough financial help and emotional support, it may be equally difficult for the patient and their loved ones. If the patient is covered by comprehensive coverage, a health insurance company may be able to give financial assistance. Because health insurance is not required by law, a potential policyholder has total discretion in selecting coverage.
Having a decent health insurance plan is an important part of any healthy financial plan. Despite growing awareness of the benefits of having a health insurance plan, many people still choose health insurance policies for their families and themselves without fully comprehending the idea. They wind up paying high premiums only to be surprised when they file a claim and discover that certain benefits/expenses really aren't covered by their health insurance plan. To know more about the regulations of health insurance, read on.

Health Insurance Regulations Every Policyholder Should Know

What Are The Regulations Under Health Insurance?

Exclusions - A health insurance policy does not offer coverage for all illnesses and diseases. Smoking-related diseases, drinking-related diseases, sexually transmitted diseases, cosmetic procedures/plastic surgery, and other lifestyle-related diseases are typically not covered by a conventional health insurance plan. While lifestyle-related difficulties, sexually transmitted illnesses, and cosmetic operations will continue to be excluded, many crucial issues such as hereditary diseases, psychiatric disorders, mental health problems, depression, and neurodevelopment disorders will no longer be excluded. This will not only serve to lessen the stigma associated with mental health concerns, but it will also offer much-needed coverage to the millions of people who are affected by them.

Alternative medicine - Alternative treatments like Ayurveda and Unani procedures were formerly included as health insurance exclusions in most health insurance plans. However, under the new IRDAI standards, a policyholder can now claim coverage for any alternative procedures, commonly known as Ayush, that are performed. If you're seeking non-restrictive health insurance for your family and yourself, inquire with your insurance provider about coverage advantages for Ayush therapies. Providers like Niva Bupa often include AYUSH coverage in all of their policies.

Additional information - While a standard health insurance plan covers unexpected health difficulties, a maternity plan is designed to cover a specific event. As a result, most typical health insurance policies do not cover pregnancy. If you and your spouse want to start a family, you should enrol as soon as possible in a health insurance plan that includes maternity coverage or a separate maternity insurance plan, as maternity benefits may only be claimed after a waiting period of three to six years, depending on the insurer. Finally, everyone from a newborn infant to senior individuals should be able to obtain health insurance benefits regardless of age, and fortunately, insurance companies are already recognising and meeting these demands.

Claim rejection - A health insurance company cannot deny a claim if the policy has been renewed without interruption for the past eight years. The moratorium period will last for eight years. Except for fraud and/or a claim brought against the policy's exclusion after the moratorium period, the insurance company cannot petition to the IRDA even against settlement of such a claim. A claim cannot be denied because of deception or non-disclosure by the insurance company. The IRDAI has granted the insurance firm an eight-year time to verify the information submitted by the policyholder, so a claim cannot be denied on that basis.


These are some of the IRDAI's most important terms and conditions, which everyone should be aware of. When shopping for a health insurance plan, one should think about these phrases and be aware of the criteria.

Also read-Understanding Multiple Benefits Of Health Insurance During COVID -19 Pandemic

How COVID-19 Reshaped The Health Insurance Sector?

Disclaimer: This article is issued in the general public interest and meant for general information purposes only. Readers are advised not to rely on the contents of the article as conclusive in nature and should research further or consult an expert in this regard.

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