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Insurance companies cannot deny health coverage if suffering from following illnesses

Not long ago insurance companies used to deny a health insurance cover if the person was suffering from a critical illness. However, the scope of health insurance policies has increased manifold recently. Now policyholders can buy health insurance even with high-risk conditions because as per regulatory guidelines insurance companies cannot deny coverage because of a certain existing condition. Insurers can now either make it as a permanent exclusion or can bring in sub-limits and restrictions according to the underwriting practices of the company.

Similarly, along with mental illness, 11 other illnesses such as psychological disorders, behavioural and neurodevelopmental disorders, genetic disorders puberty and menopause-related disorders are removed from the exclusion list. It means that the insurer has to cover them in the existing policies.

Existing diseases allowed to be permanently excluded

The regulator in the year 2020 allows insurers to underwrite 16 illnesses as permanent exclusions in health insurance policies. Now policyholders can buy health insurance even with below mentioned existing conditions which are considered high risk by insurers. Insurers can make these diseases as permanent exclusions or introduce other restrictions while still covering the policyholder.

“Insurers are allowed to incorporate the following existing diseases disclosed by the person to be insured at the time of underwriting as permanent exclusions with due consent of the proposer or person to be insured, where underwriting policy of the insurer does not enable the insurer to offer the health insurance coverage for the given existing disease disclosed even after levying the loading. The permanent exclusion would be specific for the following listed conditions. However, it is emphasized that these permanent exclusions shall be allowed only in cases where the policyholder may be denied coverage as per the underwriting policy of the Insurer for the existing diseases disclosed at the time of underwriting,” IRDAI earlier stated in the circular.

Here is the list of 16 existing illnesses that are allowed to be permanently excluded:

1. Sarcoidosis
2. Malignant Neoplasms
3. Epilepsy
4. Heart ailment congenital heart disease and valvular heart disease
5. Cerebrovascular disease (Stroke)
6. Inflammatory bowel diseases
7. Chronic liver diseases
8. Pancreatic diseases
9. Chronic kidney disease
10. Hepatitis B
11. Alzheimer’s disease, Parkinson’s disease
12. Demyelinating disease
13. HIV & AIDS
14. Loss of hearing
15. Papulosquamous disorder of the skin
16. Avascular necrosis (osteonecrosis)

Last but not the least, these policies may come with a waiting period and sublimits. Hence, before opting don’t forget to check the fine print which can later help in the smooth settlement of claims.