A staggering 98% of India's elderly population lacks health insurance. This leaves approximately 135 million senior citizens without financial protection against medical expenses. (Representative image: Pexels)  
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IRDAI Increases Senior Citizen Health Insurance Premiums By 10% Annually

Protecting Seniors: IRDAI Introduces Strict Controls on Health Insurance Premium Increases

MBT Desk

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.

Required Actions for Insurers

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 premiums
Hanut 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."

Over half of health insurance policyholders in India experienced premium hikes exceeding 25% in the past year, with 21% reporting increases of 50% or more. Such sharp rises can make it challenging for seniors to maintain continuous coverage. (Representative image: Pexels)

Market Context

  • 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)

Implementation Requirements

Hospital Network Management:

  • 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)

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