Syllabus
GS Paper 2 – Issues Relating to Development and Management of Social Sector/Services relating to Health, Education, Human Resources.
Context
The Insurance Regulatory and Development Authority of India (IRDAI) has abolished the age cap of 65 years for buying health insurance policies. This move aims to expand the market and ensure sufficient coverage against healthcare costs.
No age restriction for health insurance
Introduction
Health insurance is a type of coverage that pays for medical and surgical expenses incurred by the insured. It’s an agreement between the individual and the insurer where the individual pays a premium in return for the insurer’s commitment to cover healthcare costs. Health insurance is crucial as it protects individuals from high medical costs, ensures access to necessary care, and promotes better health overall. In recent times, regulatory bodies like the Insurance Regulatory and Development Authority of India (IRDAI) have been making efforts to make health insurance more accessible to all age groups.
Inclusive Approach Towards Comprehensive Coverage
- Shift in Insurance Regulations: The insurance regulator’s recent move marks a significant shift from the traditional restrictions that hindered individuals from securing comprehensive coverage.
- Promoting Inclusive Healthcare: By removing the upper age limit for procuring health insurance plans, the IRDAI aims to cultivate a more inclusive and accessible healthcare system, ensuring sufficient protection against unforeseen medical costs. Previously, individuals were only allowed to purchase a new insurance policy until the age of 65. However, with the new regulations effective from April 1, anyone, irrespective of their age, can acquire a new health insurance policy.
- Unconditional Coverage: Insurers have been instructed to provide health policies to individuals with any type of pre-existing medical conditions.
Health Insurance Policy for senior citizen: New rules
- Age Limit Removal: Individuals above 65 years can now easily purchase health insurance as the age restriction has been lifted.
- Special Policies for Senior Citizens: IRDAI has instructed insurance companies to devise special policies for senior citizens and establish an efficient system for prompt resolution of their policy-related complaints.
- Inclusive Coverage: Health insurance companies are now prohibited from denying coverage to individuals with pre-existing conditions such as cancer, heart or kidney failure, AIDS, etc.
- Flexible Premium Payment: Policyholders now have the option to pay premiums in installments, especially for special policies that may have higher premiums.
- AYUSH Treatment Coverage: There is no limit on the coverage for AYUSH treatments (Ayurveda, Yoga, Naturopathy, Unani, Siddha, Homeopathy), allowing policyholders to claim the entire sum insured.
- Reduced Waiting Period: The waiting period for new policyholders has been reduced from 48 months to 36 months. All pre-existing health conditions will be covered after this period, regardless of whether the disease was disclosed at the time of policy purchase.
Potential Issues and Challenges
- Policy Terms and Conditions: Insurance companies might be hesitant to serve the 65-plus age group. Even if they do, the terms and conditions of such insurance policies might not be customer-friendly.
- High Premiums: An individual aged 70, who might now be able to purchase health insurance for the first time, could face strict terms, exclusions, and potentially high premiums.
- Pre-existing Conditions: As individuals in the 65-plus age group often have pre-existing conditions, insurers will meticulously assess the profitability, sustainability, and scalability of their policies for this demographic.
Benefits of Health Insurance for Seniors
- Financial Coverage: Health insurance aids in covering substantial medical expenses, thereby making treatments more affordable.
- Quality Healthcare Access: Health insurance ensures that seniors have improved access to quality healthcare services. It guarantees timely medical care without financial hindrances, including access to specialists and cutting-edge medical treatments.
- Shield Against Escalating Healthcare Costs: With the progression of medical technology, healthcare costs are on the rise. Health insurance provides a safeguard for seniors against these escalating costs, especially those associated with chronic conditions that become more prevalent with age.
- Preventive Care: Health insurance includes coverage for routine check-ups, enabling early detection of health issues.
- Cashless Treatment: The majority of health insurance plans provide a cashless treatment facility at network hospitals, relieving seniors from the burden of arranging funds during hospitalization.
- Tax Benefits: The premiums paid towards health insurance are eligible for tax deductions, thereby reducing taxable income.
Conclusion
The removal of the age restriction for health insurance by IRDAI marks a significant step towards inclusive healthcare in India. This move not only broadens the accessibility of health insurance to seniors but also ensures their financial protection against escalating healthcare costs. Despite potential challenges such as high premiums and stringent policy terms, the benefits outweigh the drawbacks. Seniors can now avail quality healthcare services, preventive care, cashless treatments, and even enjoy tax benefits. This progressive policy change underscores the commitment to safeguard the health of all citizens, regardless of age, and is a commendable stride towards universal health coverage.
References: Indian Express | Business Standard
Related PYQ
“Besides being a moral imperative of a Welfare State, primary health structure is a necessary precondition for sustainable development.” Analyse. [UPSC Civil Services Exam – 2021 Mains]
Practice Question
How does the newly introduced health insurance policy for senior citizens in India enhance their access to healthcare, and what are the crucial benefits of it? [150 words]
How to approach this question?
Introduction (50 words):
- Start by briefly introducing the new health insurance policy for senior citizens in India.
- Mention the key changes brought about by the Insurance Regulatory and Development Authority of India (IRDAI), such as the removal of the age cap on buying health insurance policies.
Body (70 words):
- Discuss the specific benefits of the policy, such as the cashless facility, attendant benefit, co-pay options, and tax benefits.
- Explain how these features enhance access to healthcare for senior citizens. For instance, the cashless facility can ease the financial burden during hospitalization.
Conclusion (30 words):
- Conclude by summarizing the impact of the policy on the health-care accessibility for senior citizens and its potential to improve their quality of life.
Remember to provide a balanced answer, incorporating relevant facts and figures, and propose feasible solutions. Structure your answer well, with a clear introduction, body, and conclusion. Also, ensure that your answer is within the word limit specified for the exam. Good luck!