IRDAI Health Insurance Guidelines 2025: Key Changes and What They Mean for You

Key IRDAI Health Insurance Reforms Explained

1. Health Insurance Is Now Accessible at Any Age

Earlier, many insurers imposed upper age limits, making it difficult for individuals above 60 or 65 to buy new health insurance policies.

Under the revised guidelines:

• Insurers can no longer deny health insurance solely based on age

• At least one health insurance product must be available to every applicant, regardless of age

This significantly improves coverage access for senior citizens and late entrants.

2. Shorter Waiting Period for Pre-Existing Diseases

Pre-existing conditions were earlier subject to long waiting periods, often delaying meaningful coverage.

The updated framework ensures:

• Maximum waiting period for pre-existing diseases is capped at three years

• After this period, insurers must provide coverage unless fraud is established

This change makes health insurance more practical for individuals with existing medical conditions.

3. Reduced Moratorium Period for Claim Security

The moratorium period defines the point after which insurers cannot deny claims due to non-disclosure (except in cases of proven fraud).

Under the new rules:

• The moratorium period has been reduced to five years of continuous coverage

• This applies even when policies are ported or migrated

This offers long-term claim certainty and peace of mind to policyholders.

4. Clearer and More Standardised Exclusions

One of the biggest sources of dispute in health insurance has been unclear exclusions.

IRDAI now mandates that:

• Exclusions must be clearly defined and transparently disclosed

• Any sub-limits or caps must be objectively justified

• Arbitrary or vague exclusions are no longer permitted

This improves comparability between policies and reduces surprises during claims.

5. Faster and More Transparent Claims Settlement

To reduce stress during medical emergencies, insurers are now encouraged to simplify claims processes and improve turnaround times.

Key expectations include:

• Expanded cashless hospital networks

• Faster decisions on cashless approvals

• Improved disclosures around claim conditions

The objective is to reduce out-of-pocket burden and procedural delays during hospitalisation.

6. Stronger Portability and Continuity Benefits

Policyholders switching insurers earlier risked losing accumulated benefits.

The updated guidelines ensure:

• Continuity benefits are preserved during porting or migration

• Waiting periods, no-claim bonuses, and moratorium credits carry forward

This gives policyholders greater freedom to switch insurers without penalty.

7. Inclusion of AYUSH Treatments Without Sub-Limits

Alternative treatments are increasingly used alongside conventional medicine.

Under the revised norms:

• AYUSH treatments (Ayurveda, Yoga, Naturopathy, Unani, Siddha, Homoeopathy) are covered up to the full sum insured

• No separate sub-limits apply

This promotes holistic healthcare choices without financial disadvantage.

8. Coverage Cannot Be Denied for Severe Medical Conditions

Earlier, individuals with serious illnesses often struggled to obtain coverage.

The new framework improves inclusivity by ensuring:

• Coverage cannot be denied solely due to severe pre-existing conditions

• Insurers must offer suitable products even for high-risk individuals

This represents a significant shift toward universal access.

9. Specialised and Customised Health Insurance Products

Recognising diverse healthcare needs, insurers are encouraged to design products for specific groups, including:

• Senior citizens

• Children and students

• Maternity and specialised medical needs

This allows policyholders to choose coverage aligned with their life stage.

10. Ability to Claim Across Multiple Policies

Policyholders holding more than one health insurance policy can now:

• Make claims across insurers, subject to policy terms

This offers additional financial flexibility during high-cost medical treatments.

What This Means for You as a Policyholder

These reforms collectively strengthen the fairness, transparency, and reliability of health insurance in India. They reduce uncertainty, improve access, and ensure that coverage works as intended across life stages.

For policyholders, the key takeaway is simple:
Health insurance is becoming more inclusive, more predictable, and more aligned with real-world needs.