The Insurance Regulatory and Development Authority of India (IRDAI) has issued a directive capping a maximum of 10% in the annual premium for health insurance policies of senior citizens. Any proposed increase beyond this limit or withdrawal of insurance products for senior citizens will require prior consultation with IRDAI.
Background and rationale
IRDAI has seen a steep hike in premium rates for senior citizens (60 years and above), with some insurers reporting hikes of up to 100% have been implemented. This has made it difficult for many elderly policyholders to afford continued coverage. Given that nearly 138 million senior citizens in India face significant health care costs—With 40% living with disability and 75% suffering from chronic diseases—uncontrollable increases in premiums have become a major concern.
Key instructions from IRDAI circular (30 January 2025):
Insurers cannot increase health insurance premiums for senior citizens by more than 10% annually.
Any proposed increase or withdrawal of senior-specific health plans above this limit must be approved by IRDAI.
Insurers should widely advertise the initiatives taken for the benefit of senior citizens.
Companies should standardize hospital listings and negotiate treatment package rates as per the PMJAY scheme.
Premium Management:
Maintain annual increases below the 10% threshold
Seek prior approval for larger adjustments
Document justification for rate changes
Product Availability:
Notify IRDAI before withdrawing senior-focused products
Maintain transparent product offerings
Ensure continued accessibility of policies
Public Disclosure:
Promote protective measures for seniors
Clearly communicate premium structures
Maintain public awareness campaigns
Industry reactions
The 14% annual increase in medical expenses compounds the challenge, particularly as premiums naturally escalate with age.Dr. Sabine Kapasi, Advisory to Global Strategy Team, United Nations
Experts have welcomed the move as a step towards making health insurance more accessible to the elderly.
This regulation introduces crucial pricing predictability, preventing policy lapses due to unaffordable premiumsHanut Mehta, CEO of Bimapay Finsure
Anantram Varayur, co-founder, of Mansam Senior Living, highlighted that "Availability remains a significant challenge, with many companies either refusing senior coverage or charging exorbitant premiums."
Previous Issues:
Reports of 100% premium increases affecting affordability
Multiple complaints from senior citizens
Reduced accessibility to comprehensive coverage
Demographic Impact:
Approximately 138 million seniors in India
40% living with disabilities
75% managing chronic illnesses (LASI data)
Implement common hospital empanelment systems
Negotiate package rates aligned with the PMJAY scheme
Streamline healthcare delivery networks
Documentation Standards:
Maintain detailed records of premium adjustments
Document consultation processes with IRDAI
Track compliance with regulatory requirements
The regulatory move aims to strike a balance between insurers' pricing strategies and ensure that India's elderly population has sustainable access to healthcare coverage.
(Input from various sources)
(Rehash/Muhammad Faisal/MSM)