The Insurance Regulatory and Development Authority of India (IRDAI) on October 18, 2022, issued a circular to provide insurance cover for newborns/infants under health insurance policies.
Clause (1) of Chapter –II on ‘exclusions not allowed under health insurance policies’ issued vide Master circular on Standardisation in Health insurance Business dated July 20, 2020, where it has been directed that internal congenital diseases, genetic diseases, or disorders are not allowed to be incorporated as exclusions in the terms and conditions of the policy contract. The intent of this provision is to cover newborns with internal congenital birth defects from Day 1.
It has been noticed by the authorities that many health insurance products that are marketed by the insurers are not providing cover to newborns/infants with internal congenital birth defects from Day 1, thereby violating the genuine intent of the provision.
Considering this, it has been stated that all insurance products that cover newborns/unborns must comply with the abovementioned provisions without any deviation and provide, coverage from Day 1 without imposing any waiting periods/sub-limits or any other restrictive conditions.
[Circular No. 30/IRDAI/HLT/GEN/ministry/2022-23]
