The Insurance Regulatory and Development Authority of India on 12th October 2022, has directed all health insurance policies to cover new-borns with internal congenital birth defects from day one (1).
As per Clause (1) of Chapter –II on ‘exclusions not allowed under health insurance policies’ issued vide Master circular on Standardisation in Health insurance Business dated 22.7.2022 wherein it has been mandated that internal congenital diseases, genetic diseases or disorders are not allowed to be incorporated as exclusions in the terms and conditions of the policy contract. The intent of the above provision is to cover newborns with internal congenital birth defects from day one.
However, it is observed that many health insurance products that are marketed by insurers are not providing cover to newborns/infants with internal congenital birth defects from day one(1) thus going against the true spirit of the above referred clause.
Therefore, it is reiterated that all insurance products that cover newborns/unborns shall comply with the above referred provisions without any deviation and provide, coverage from day one without imposing any waiting periods/sub-limits or any other restrictive conditions.