Taking note of steep rise in health insurance premiums that senior citizens are compelled to pay, IRDAI has directed all general and health insurers offering indemnity based individual health products to those above 60 years not to revise the insurance premiums by more than 10% per annum.   

The directive which comes into force with immediate effect says that in case increase proposed in premium is more than 10% or in case of withdrawal of individual health insurance products offered to senior citizens insurers shall take prior consultation with IRDAI.

The authority has directed insurers to give wide publicity of various measures including the above taken for the benefit of senior citizens while offering health insurance products. It has said that insurer will take necessary steps for common empanelment of hospitals and negotiate package rates on the lines of PMJAY.

Issuing a press statement IRDAI has said that for the benefit of senior citizens the regulatory framework requires all insurers to establish a separate channel to address their health insurance related claims grievances. The details of such channel are required to be published on the respective  insurers  website .

“As part of the ongoing  monitoring of insurance products offered in  the insurance market  it is observed that there has been a steep increase in premium rates under some of the health insurance products offered to senior citizens (aged 60 and above),” it says.

It adds that the premium rate is primarily based on the estimated claims outgo and expenses including  and acquisition costs incurred by the insurance company for acquiring and servicing the insurance policies. The claims outgo is largely dependent on the amount charged by the hospitals for various treatments/ surgeries” it says .

IRDA adds that unlike in the case of Pradhan Mantri Jan Arogya Yojana  (PMJAY) where hospitalization expenses are negotiated centrally for package rates and are thus standardised across various hospitals , there is no such standardisation in case of health insurance products . “ This is leading to  hospitalizations costs  resulting in higher claims outgo under health insurance  products  offered by insurers. This impacts senior citizens,  the most as they have limited source of income.”