Decoding IRDA’s 65 Years Age Rule in Health Insurance


Decoding IRDA's 65 Years Age Rule in Health Insurance

Many of you have seen IRDA’s recent circular stating that from April 1, 2024, insurance companies are not required to follow the entry age limit of 65 years for health insurance plans. This has created a buzz among the general public, especially senior citizens. Many news channels have published news that from now on, there would not be any upper limit of 65 years in a health insurance policy, and senior citizens aged >65 years could benefit from this move.

Surprisingly, the circular is being misinterpreted by news outlets, and what is more surprising is that insurance industry veterans are also misinterpreting this circular.

Let us look into what IRDA would have meant with this circular and what it could mean for the insurance companies and the policyholders.

What is the Circular From IRDA About?

In 2016, IRDA, in its circular, mentioned that insurance companies should offer health insurance plans to individuals at least until the age of 65. This meant the entry age for a health insurance policy should be at least 65. So, an individual can take a health insurance policy up to 65 years of age and then renew it every year, as 65 is the upper limit for entry age in a health insurance policy.

On April 1, 2024, IRDA released another circular regarding the new health insurance product regulations. This circular specifically skipped mentioning the upper entry age limit of 65 years. Instead, IRDA said there would be no age limit for health insurance plans sold in India.

Does it Means That Insurance Companies Should Mandatorily Cover Senior Citizens Above 65 Years?

No, IRDA does not compel insurance companies to cover senior citizens above 65 years of age from April 1, 2024. The circular skipped the upper entry age limit of 65, which has created multiple opinions among the public.

Before April 1, insurance companies had created health insurance plans for regular and specific customers. For example, senior citizen health insurance plans were specifically designed for seniors, and regular health insurance plans could be opted for by anyone up to the upper entry age limit, usually 65 years old.

What has Changed now for Insurance Companies and Customers?

There is no rule for insurance companies that the upper entry age limit should be 65, which could mean that insurance companies may have reduced the upper entry age limit. For example, insurance companies may have an upper entry age limit of 25, 40, 50 years, etc., as they create targeted products.

On the other hand, this may not lead to a better situation than what exists now. Insurance companies are under no obligation to insure senior citizens over 65, as they have the right to accept/reject an insurance policy based on their underwriting guidelines. IRDA has not taken away the insurance company’s underwriting rights.

This could lead to the creation of targeted health insurance plans for senior citizens, as they are now forced to pay higher premiums under a regular health insurance policy for their age group. Conversely, if a senior citizen opts for a senior citizen health insurance policy, the premium would be affordable. IRDA intended to permit insurance companies to develop targeted health insurance plans for multiple age groups to make health insurance affordable.

How do the New Regulations Benefit Elderly Policyholders?

The benefits for elderly policyholders from the new regulations are multifold.

  • The pre-existing waiting period has been reduced from 4 years to 3 years, which applies to both new and existing policyholders. 
  • The moratorium period—the period during which an insurance company could contest a claim — was reduced from 8 years to 5 years. 
  • This may lead to the development of targeted health insurance plans for senior citizens. The new plans might be affordable to most senior citizens, as the existing regular plans are proving to be costly. 

Check out our blog for detailed information on the updates on the moratorium period and pre-existing waiting period.

So, as News Reports Claim, Is There Any Positive News for Senior Citizens?

We have to wait and see how the insurance companies react to the recent IRDA circular. It could happen that they discontinue insurance products for individuals over 60-65 by reducing the entry age.

This may also lead to more innovative health insurance plans for senior citizens over 65. Targeted health insurance plans for different age groups may emerge, which may benefit society as a whole.

Bajaj Allianz General Insurance, Manipal Cigna, and Star Health Insurance have already launched dedicated health insurance plans targeting different sections of society. For example, we have plans for senior citizens, cancer survivors, children, women, individuals with diabetes and hypertension, etc. For more information on these plans and their suitability to your needs and requirements, please contact us now.


  1. Which insurance companies are offering health insurance plans for senior citizens?

    Here are a few companies that are offering health insurance plans for senior citizens in India:Aditya Birla Active CareBajaj Allianz Silver Health PlanCare Senior Health Advantage planChola MS Flexi health planDigit health plansFuture Generali Varista BimaHDFC ERGO Optima Senior PlanMagma HDI One Health Senior Plan

  2. What is the waiting period for a senior citizen's health insurance plan?

    As per the new circular of IRDA, the waiting period for pre-existing diseases in a health insurance policy has been reduced from 4 years to 3 years. This would apply to all the health insurance plans available in the market.

  3. What is co-payment in a health insurance plan?

    Co-payment is the amount of the claim that the policyholder has to bear at the time of claim settlement. Some senior citizen plans have a mandatory co-payment that could be up to 20% of the sum insured.

  4. How do we handle rising healthcare costs?

    The best way to handle rising healthcare costs is to purchase a health insurance policy that covers all your needs.

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Susheel Agarwal