In Alzheimer's, Parkinson's, AIDs/ HIV acquired after the policy inception should not be excluded. It has recommended that there should be no permanent exclusion in the policy wordings for any specific disease, whether it is degenerative, physiological or chronic in nature.

The Insurance Regulatory and Development Authority of India (Irdai) 's working group report for standardization of exclusions in health insurance contracts has recommended that waiting periods for any specific disease can be a maximum of four years. However, waiting for periods such as hypertension, diabetes, cardiac cannot be for more than 30 days.

The panel had initially recommended a list of 17 conditions for which insurers can incorporate permanent exclusions if they are pre-existing at the time of underwriting. It also suggested that a standard format of consent letter to be given by the proposer may be specified. Sub-limits or annual policy limits for specific diseases in terms of amount, percentage of sum insured and number of days of hospitalization will be part of the policy design.

Non-disclosed conditions

Non-declaration or misrepresentation of material facts is a major concern in health insurance. The working group has recommended that after eight years of continuous renewals, claims can not be questioned based on non-disclosure or misrepresentations when taking policy. The policy will be incontestable in terms of application of any exclusions except for proven fraud as well as permanent exclusions specified in a policy contract.

Standardization of exclusions

The panel has recommended that exclusions because of alcohol or substance abuse must be reviewed and standardized. This exclusion will be modified to exclude only treatments for alcoholism and drugs. It has also recommended the formation of the Health Technology Assessment Committee, which will examine and recommend inclusion of advances in medical technology as well as new treatments/ drugs for coverage under insurance.standardised.

This exclusion will be modified to exclude only treatments for alcoholism and drugs or substance abuse unless associated with mental illness. It has also recommended the formation of Health Technology Assessment Committee, which will examine and recommend inclusion of advancements in medical technology as well as new treatments/ drugs for coverage under insurance.

It has also recommended that "no exclusions" should be permitted for any advancement in technology or advance treatments if these are in the list approved by this committee. However, insurers can either incorporate co-payments for such treatments or subject them to the usual, customary and reasonable clause. Insurers can not deny coverage for claims of oral chemotherapy and peritoneal dialysis.

Health covers 

The panel has also said that new treatments such as balloon sinuplasty, deep brain stimulation, oral chemotherapy, immunotherapy, robotic surgeries, and stem cell therapy may be included in health covers. In case of migration to another policy because of the withdrawal, the policyholder will be given credit to the accrued gains of pre-existing diseases waiting period to the extent that is possible in the porting of the product or porting in product, whichever is less.

In order to make the pricing structure transparent, the panel has suggested that every document should be published in the list of items which will be billed separately and make it available to the insured in the policy contract or as a link on the website.