In a bid to make health insurance more simple and customer-friendly, the Insurance Regulator and Development Authority of India (IRDAI) recently amended the definition of pre-existing diseases. It deleted ‘the additional/modified clause’ in its current definition of pre-existing diseases through a circular dated 10 February 2020. This move could definitely help in reducing claim rejection rates by the health insurance companies.
Pre-existing disease is a condition, ailment or injury that already exists at the time of buying a health insurance policy. Conditions like diabetes, epilepsy, lupus, sleep apnea, depression and anxiety are considered as pre-existing health conditions.
To include certain illness under health insurance policy, the regulator had modified the definition of pre-existing disease through a circular in September, 2019. It added that if certain illnesses were diagnosed within 3 months of buying the health insurance policy, those would be considered as pre-existing diseases and covered under the policy. However, according to the latest circular, no such diseases will be treated as pre-existing diseases even if diagnosed within three months, or later, after purchasing the health insurance policy. The insurance regulator also mentioned that the modification will be included in the guidelines on standardization in health insurance policies.
| S. No. | Reference | Existing | New |
| 1 | Definition of Pre-Existing Disease | Pre-existing Disease means any condition, ailment, injury or disease:
a) That is/are diagnosed by a physician within 48 months prior to the effective date of the policy issued by the insurer or b) For which medical advice or treatment was recommended by, or received from, a physician within 48 months prior to the effective date of the policy or its reinstatement. c) A condition for which any symptoms and or signs if presented and have resulted within three months of the issuance of the Policy in a diagnostic illness or medical condition. |
Pre-existing Disease means any condition, ailment, injury or disease:
a) That is/are diagnosed by a physician within 48 months prior to the effective date of the policy issued by the insurer or its reinstatement or b) For which medical advice or treatment was recommended by, or received from, a Physician within 48 months Prior to the effective date of the policy issued by the insurer or its reinstatement (Life insurers may define norms for applicability of PED at Reinstatement) c) (Deleted) |
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Any information about CORONA Disease? IS it included ?
Check with your Insurer…. and your policy details.
Apollo Munich now HDFC ergo includes corona for its specific policies.