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Health Insurance Pre-Existing Conditions

IRDAI Rules for Pre-Existing Diseases Cover


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About Pre-Existing Disease Cover Health Insurance

Health insurance is an armor that protects the policyholders from unforeseen medical emergencies. But, things are not rosy for individuals who have pre-existing diseases (PED). Some companies do not provide full coverage for pre-existing diseases or some have a long waiting period. However, the latest announcement of IRDAI (Insurance Regulatory Development Authority of India) came up with the good news for the insurance holders diagnosed with pre-existing conditions.

What are Health Insurance Pre-Existing Conditions?

Basically, health insurance pre existing conditions mean the illness, injury or other condition that existed before the issuance of the policy. Diabetes, COPD, cancer, epilepsy, depression, anxiety, and sleep apnea are some common examples of PED.

IRDAI Announcements on Health Insurance Pre-Existing Conditions

According to the new circular, the definition of "health insurance pre-existing conditions" has been changed and modified. Let's read more about health insurance pre-existing diseases, the new amendment by IRDAI, and how it is beneficial for pre-existing disease policyholders?

Health Insurance Pre-Existing Conditions Old vs New

Old Definition of Pre-Existing Diseases

New Definition of Pre-Existing Diseases

That is diagnosed by any physician within 48 months, before the effective date of the policy issued by the insurance company.

That is diagnosed by any physician within 48 months, before the effective date of the policy issued by the insurance company.

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

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

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.

According to the amendment IRDAI has deleted this clause.

Therefore, according to the new amendment, no disease or illness shall be considered as a pre-existing disease if it is diagnosed within 3 months from the date of buying the policy.

Note: However, the modification in health insurance pre-existing conditions is not applicable to travel insurance.

How are Health Insurance Pre-Existing Conditions Beneficial for Policyholders?

It is a piece of good news for the policyholders who are suffering from pre-existing diseases. IRDAI has now deleted the additional/modified clause. See how it is beneficial for a policyholder:

  • It could lead to a reduction in unnecessary claim rejection by the insurer
  • It takes away most of the ambiguities in pre-existing diseases
  • Insured will disclose the true medical history
  • Insured with PED get more coverage
  • IRDAI advised all the health insurance companies and TPA (Third Party Administrators) to make the amendments with immediate effect and ensure compliance

Therefore, health insurance has now become a necessity. However, earlier for the people with pre-existing conditions it was difficult to get complete coverage. IRDAI initiative is really helpful for the people who cannot afford the on-going treatment of their pre-existing disease. Now even if they are diagnosed with such chronic diseases after buying a policy they will get the claim.

Trusted brands like Religare Health Insurance offers cashless health insurance plans to the people with pre-existing diseases so that they can avail the best possible treatment with maximum coverage and financial security.

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