Exposure Draft on Guidelines on Standardization of Exclusions in Health Insurance Contracts and Modification Guidelines on Product Filing in Health Insurance

May 17, 2019 | by Avantis RegTech Legal Research Team


The Insurance Regulatory and Development Authority of India (IRDAI) on May 16, 2019, has published a Draft guidelines on standardization of exclusions in health insurance contracts and modification guidelines on product filing in health insurance. These guidelines are issued under the provisions of Insurance Act, 1938 and the IRDAI Act 1999.

On examining the recommendations of the Working Group for Standardization of Exclusions in Health Insurance Contracts, it is proposed to issue the following Guidelines:

1. Guidelines on Standardization of Exclusions in Health Insurance Contracts

2. Modification Guidelines on Product Filing in Health Insurance

3. Modification Guidelines on Standardization in Health Insurance

The main objective of these guidelines are to rationalise and standardize the exclusions in health Insurance Contracts that every insurer shall comply with. These Guidelines are applicable to all General and Health Insurers offering indemnity based health insurance (excluding PA and Domestic / Overseas Travel) policies offering hospitalisation, domiciliary hospitalisation and day care treatment.

These Guidelines are issued specifying 

(i) the exclusions that are not allowed in the Health Insurance Policies,

(ii) Standard Wordings of some of the exclusions 

(iii) Existing Diseases that may be permanently excluded 

(iv) Modern Treatment Methods that shall be covered 

(v) other Norms on Exclusions. 

All stakeholders are requested to offer their comments or suggestions on the proposed Guidelines by May 31, 2019. The comments or suggestions may be mailed to [email protected] and [email protected].   


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