Health Insurance Guidelines#
IRDAI Guidelines for Health Insurance#
The Insurance Regulatory and Development Authority (IRDAI) has framed specific guidelines for health insurance.
Key Health Insurance Products#
| Product | Coverage |
|---|---|
| Individual Health | Single person |
| Family Floater | Family members |
| Senior Citizen | Above 60 years |
| Group Health | Employer groups |
| Critical Illness | Specific diseases |
Coverage Features#
- In-patient treatment: Hospitalization expenses
- Day care procedures: Less than 24 hours
- Pre and post hospitalization: Medical expenses
- Ayush treatment: Ayurveda, Yoga, etc.
- Ambulance charges: Transportation costs
- Health check-up: Preventive health
Common Exclusions#
- Pre-existing diseases (waiting period)
- Cosmetic treatments
- Self-inflicted injuries
- War/nuclear perils
- Pregnancy (unless added)
- Mental illness (new coverage available)
Claim Process#
- Notify insurance company
- Submit required documents
- Verification process
- Claim settlement
- Payment to hospital/insured
Key IRDAI Guidelines#
- Portability: Switch insurer without loss
- Renewal: Lifelong renewal option
- Deductibles: Optional amount borne by insured
- Co-payment: Shared claim cost