2025 Revised Health Insurance Premium for Senior Citizens
- February 07, 2025
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2025 Revised Health Insurance Premium for Senior Citizens
The Insurance Regulatory and Development Authority of India (IRDAI) has rolled out new measures to address the rising health insurance premiums for senior citizens. This group is increasingly affected by the rising healthcare costs, and has somewhat been helpless since most individuals that make up this group are retired and have limited funds.
In order to ensure health insurance premium is affordable, the IRDAI has set guidelines to cap premium hikes and compel the insurers to adopt practices that ensure cost-effective coverage for the elderly. These guidelines aim to protect the interests of senior citizen policyholders by promoting affordability and accessibility to necessary healthcare services through health insurance.
Read this post to learn about the IRDAI's new guidelines to control health insurance premium hikes for senior citizens.
Reforms taken by IRDAI for Policyholders
The Insurance Market regulator IRDAI has undertaken a series of reforms in recent times to support the empowerment of policyholders and strengthen inclusive health insurance, while providing a suitable environment for the ease of doing business for health insurance companies and offering a wide range of insurance plans to customers.
Some of the measures taken by IRDAI in the interest of policyholders include mandatory time limits for cash claim approval, mandating insurers to make add-ons and riders available to provide wider choice to policyholders, etc.
The moratorium period and the time frame for taking pre-existing conditions into account have witnessed a reduction. Every policy document must include a Customer Information Sheet (CIS), which provides a concise explanation of the fundamental aspects of insurance policies, including the type of insurance, sum insured, coverage details, exclusions, sub-limits, deductibles, and waiting periods.
Additionally, the regulatory framework mandates that all insurers set up a distinct channel to handle claims and complaints pertaining to health insurance for the benefit of older residents. The specifics of such a channel must be posted on the website of the respective insurer.
IRDAI observes Senior Citizens most affected by Rising Premiums
IRDAI has observed that premium rates for certain health insurance plans for elderly citizens (those 60 years of age and over) have sharply increased as part of the continuous monitoring of insurance products available in the Indian insurance market.
The insurance firm mostly determines the premium rate based on the estimated claims outgo and expenses, such as acquisition costs, incurred for acquiring and maintaining the insurance policies. The claims outgo mainly depends on the amounts charged by hospitals for different treatments and surgeries.
Senior persons with restricted incomes are the most vulnerable age group in this context, and they are the ones who suffer the most whenever there are steep increases in health insurance premiums. This issue has been attracting IRDAI's attention.
IRDAI’s Directions for Insurers with Immediate Effect
In order to uphold the interests of senior citizens, the insurance regulator has directed all general and health insurers to follow the following guidelines with immediate effect:
- Insurers cannot revise premiums charged from senior citizens by more than 10% annually.
- They must consult the IRDAI beforehand in the following scenarios:
- If the suggested premium increase for senior citizens exceeds 10% annually.
- Insurers must consult the IRDAI beforehand if they want to withdraw senior citizens' individual health insurance products.
- When providing health insurance products, the insurers must give wide publicity of the various measures taken for the benefit of senior citizens.
- The insurer shall take the required actions to ensure the common empanelment of hospitals and negotiate package pricing in accordance with the Pradhan Mantri Jan Arogya Yojana (PMJAY) Scheme.
For assistance in ensuring compliance with the guidelines of IRDAI, connect with Insurance Consultants at Registrationwala.
Also Read: How to Become Health Insurance Broker?
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