Health insurance regulations every policyholder must know about
Health insurance regulations every policyholder must know about

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Health insurance regulations every policyholder must know about

Max Bupa

12 February 2020

Investing in a good health insurance plan is a crucial component of any sound financial strategy. Despite the increasing awareness regarding the benefits of getting a health insurance plan, many people still end up picking health insurance policies for family and self without completely understanding the concept. They end up paying hefty premiums only to get a rude shock when they find out that certain benefits/expenses are not covered under their health insurance plan while making a claim.

To curb this issue, the Insurance Regulatory and Development Authority of India (IRDAI) has made some changes which aim to bring in a certain degree of standardisation in the health insurance industry and make health insurance plans easier to understand for the common man.

Hence, before you zero in on a health insurance plan, it is important to assess the needs of health insurance for family and self-based on age, health and financial conditions. Only then can you proceed to evaluate the health insurance plan based on the kind of coverage/benefits available and the health insurance exclusions which are specific to the policy.

To help you out in this process, here are some common health insurance regulations you should be aware of:

List of health insurance exclusions

A health insurance plan does not provide a blanket cover against all ills and ailments. Lifestyle-related diseases such as those caused by smoking, drinking, sexually transmitted diseases, cosmetic procedures/plastic surgery etc. are usually not covered under a standard health insurance plan.

While lifestyle-related issues, sexually transmitted diseases and cosmetic procedures continue to remain outside the scope of coverage, many critical issues such as genetic diseases, psychological disorders, mental health problems, depression and neurodevelopment disorders will not be a part of health insurance exclusions anymore.

This will not only help reduce the stigma around mental health issues but also provide the much-needed coverage for millions who suffer from them.

Alternative medicine

Until recently, alternative treatment options such as Ayurveda and Unani procedures were listed as health insurance exclusions under most health insurance plans. However, with the new IRDAI guidelines, a policyholder can now claim coverage for treatment under any alternative procedures, also known as Ayush.

If you are someone who is looking for health insurance for family and self that is not restrictive, feel free to ask the insurance provider if they offer coverage benefits for Ayush treatments. Providers such as Max Bupa tend to offer AYUSH coverage with all their plans.

Additional information

While a regular health insurance plan provides coverage against unforeseen health issues, a maternity  plan is taken as a definite event. Thus, most standard health insurance plans do not offer maternity coverage. So, if you and your partner plan to become parents, you should opt for a health insurance plan that offers maternity coverage or a specific maternity insurance plan as soon as possible as maternity benefits can only be claimed after a waiting period which ranges between three to six years, depending on the insurer.

Lastly, everyone from a newborn baby to senior citizens should be able to avail health insurance benefits without any age restriction and luckily, insurance providers these days are recognising and accommodating these needs for you. Want to know more about these plans that give you umbrella coverage? Head on over to

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