Good news for health insurance policyholders! IRDAI revises definition of pre-existing diseases

By: |
February 10, 2020 8:53 PM

As per the new definition, now no such disease will be treated as a pre-existing disease even if diagnosed within the earlier mentioned time period of buying the health insurance policy.

IRDAI, irda, Health Insurance, Disease, Claims, PED, Illness, insurance regulator, health insurance planDefinition of Pre-existing Diseases as per IRDAI

The Insurance Regulator and Development Authority of India (IRDAI) has brought in changes to the definition of pre-existing diseases. Through a circular dated February 10, 2020, IRDAI has deleted ‘the additional/modified clause’ in its current definition of pre-existing diseases. Experts say this move could bring in a reduction in the claim rejection rates in health insurance policies.

The regulator had modified the definition of pre-existing diseases last year. IRDAI had included certain illnesses if they were diagnosed within 3 months after purchasing the health insurance policy. However, as per the new definition, now no such disease will be treated as a pre-existing disease even if diagnosed within 3 months, or later, of buying the health insurance policy.

Definition of Pre-existing Diseases as per IRDAI

The existing definition of Pre-Existing Disease sates that (not applicable for Overseas Travel Insurance) pre-existing disease means any condition, ailment, injury or disease:

i) Old definition: That is diagnosed by any physician within 48 months, preceding the effective date of the policy issued by the insurer.

New definition: That is diagnosed by a physician within 48 months preceding the effective date of the policy issued by the insurer or its reinstatement.

ii) Old definition: For which medical advice or treatment was received from a physician within 48 months preceding the effective date of the policy or its reinstatement.

New definition: Any illness for which medical advice or treatment was recommended, or received from, a physician within 48 months preceding to the effective date of the policy issued by the insurer or its reinstatement.

iii) Old definition: Any condition for which symptoms or signs if presented and have resulted within 3 months of the issuance of the policy in a diagnostic illness or medical condition.

New definition: Deleted

What is pre-existing condition?

Insurance companies consider medical illness or injury that have occurred to the policyholder before he/she started a new health plan as a pre-existing condition.

Examples of pre-existing health conditions

Conditions like diabetes, COPD, cancer, lupus, epilepsy, depression, anxiety, sleep apnea, etc. fall under pre-existing health conditions, mostly which tend to be chronic or long term.

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