No, IRDAI has not removed the 65-year-old regulation ceiling on older persons' eligibility to get health insurance. The norms signify what they say.

No, IRDAI has not removed the 65-year-old regulation ceiling on older persons' eligibility to get health insurance. The norms signify what they say.

Effective April 1, IRDAI omitted the 65-year entrance age clause from its rules; nevertheless, this does not imply that it has done away with any "cap" that was in place prior to March 31. In fact, several insurers are lowering the maximum entry age under their standard health insurance, notwithstanding the rumors. While celebrating, senior folks should be aware of this fact

Will the new health insurance laws from IRDAI actually help older citizens?

It seems that the Insurance Regulatory and Development Authority of India (IRDAI) has made a mistake, which may have taken some policyholders off guard.

The most recent policy update from the IRDAI, which went into effect on April 1, failed to include a crucial provision requiring insurers to provide health coverage to policyholders until at least age 65. Keep in mind that this isn't a legal ceiling. But there has been a lot of talk on social media and in the insurance industry generally about how the IRDAI is now "allowing insurance companies to sell health policies to those over the age of 65."

What then transpired? Under the regulator's new rules for health insurance products, there is no reference of the 65-year-old entry age "floor," which prevents insurers from refusing policy proposals from applicants alleging age discrimination below that age. In other words, under the previous Health Insurance Regulations, 2016, which remained in effect until March 31, IRDAI required insurers to provide plans to customers at least until the age of 65.

Before April 1, when IRDAI's new product rules went into effect, were insurers prohibited from providing health coverage to anyone over 65?

No. It is false to say that IRDAI has just recently permitted insurers to provide standard health insurance to anyone over 65. Insurance firms have always been able to provide coverage to those over 65 without facing any regulatory restrictions. In reality, a number of the insurers' standard policies are already available to those beyond that age.

"All health insurance policies shall ordinarily provide for an entry age of at least up to 65 years," according to the IRDAI's Health Insurance Regulations, 2016, which became obsolete on April 1. Stated differently, they could always provide, as many employers currently do, regular coverage to anyone over 65. Furthermore, a lot also provide plans tailored to older citizens.

Therefore, until March, insurers were required to take into account suggestions from individuals up to the age of 65; they were not permitted to flatly reject such plans on the grounds of an age restriction. Nikhil Apte, chief product officer, Product Factory (Health Insurance), Royal Sundaram General Insurance, says, "Some may have collected advantage of the 65-year rule to turn down insurance applications compared to senior citizens, but now, insurance companies may have to design products as well as put out premium charts for all age groups."

Yet, this does not imply that IRDAI has done away with any age restriction or made coverage for seniors mandatory. It is still up to insurers to decide whether to offer coverage and set rates.

Due to their late age and existing medical issues, older folks' premiums are often unaffordable, making standard health coverage unattainable for them. Even in the wake of new restrictions, insurers have the right to reject such offers if their underwriting exercise—which involves assessing risk and setting premiums—indicates that the idea is too hazardous to provide coverage.

What has changed since April 1st, then? After April 1, would older folks be eligible to get health insurance due to a change in IRDAI regulations?

As previously indicated, insurers provided older individuals with specialized and regular health products even prior to April 1. As of right now, IRDAI has just left out the reference to "65 years."

The existing state of affairs on the ground won't improve as a result of this. It is not because IRDAI has ever prohibited the sale of new policies to seniors, but rather the outrageous costs offered for their age group make it impossible for seniors to get standard health insurance coverage.

Additionally, the regulator has reportedly requested insurers to make sure that their health insurance plans are appropriate for all age groups. This does not imply, however, that insurers will have to provide everyone with their standard health coverage. As is currently the case, they might create items specifically for certain demographics, including older people.

Furthermore, insurers were compelled under previous legislation to provide coverage to a range of age groups and demographics. According to the 2016 rules, "health insurance products may be designed to offer various covers: for a particular age or gender groups...for different age groups."

But from the standpoint of the senior policyholder, are the rules generally beneficial?

Advantages include a shortened moratorium period for contesting claims (down from eight years to five), a modified definition of pre-existing illness (period diagnosis or discovery that are brought down from four years to three), alongside a reduced maximum waiting period for such illnesses (as small as from four years to three).

But it might also prove to be a foolish decision to leave out 65 years as the minimum age at which insurance proposals cannot be denied due to old age. It used to be required for all items to have an entrance age of up to 65 years. As of right now, some insurers may create plans with entry-level eligibility (at the time of purchase) ranging from, say, 18 to, at most, 35, 40, or 50 years old. According to Bhabatosh Mishra, head of underwriting for products and claims at Niva Bupa Health Insurance, "this it will enable more innovative and targeted products towards many different age cohorts."

This shift doesn't necessarily have a lot of benefits for older individuals. Insurers have the authority to provide policies to anyone over 65 years of age even earlier. In fact, it's considerably better news for the younger population, Mishra continues.

Hence, contrary to popular belief, leaving out the age of 65 might actually be bad for senior policyholders, who would then have to choose from the few senior citizen-specific plans that are on the market. "Insurers may choose that only those up to, say, 55 or 60 years old will be eligible for their standard insurance. Others could have to make do with coverage meant for senior citizens, according to First Policy Insurance Brokers regional head Hari Radhakrishnan.

Can elderly people ever expect to get plans that pay for their medical costs at a reasonable price?

Insurers will need to devise creative and cost-effective solutions to providing health coverage to the elderly population, since there is still a significant unmet need in this segment. In 2023, a number of insurers, including as Bajaj Allianz and ManipalCigna, introduced new plans geared at the senior population. If other businesses follow suit, health insurance may become more affordable for the silver population.