IRDAI Changes Pre-existing Disease Rules?

Published On 02 Mar 2020 By Yamini Sharma

Pre-existing Disease Rules Changed to Benefit Policyholders!

About to make your first health insurance investment?

Looking for a health insurance policy that meets your medical requirements perfectly?

Does your online hunt for an ideal health insurance plan involve pre-existing disease coverage? If so, you are at the right place!

This article will help you explore changes that IRDAI has made in its pre-existing disease rules.

However, those new to the concept of pre-existing disease or IRDAI, it would be important for you to learn the basic of these concepts in the first place.

Let’s start with pre-existing disease.

Pre-existing disease meaning

A pre-existing disease is a medical condition or illness that exists at the time of a policy purchase. A pre-existing disease can be chronic or long-term. Note that pre-existing diseases are generally excluded from being covered during an initial waiting period. The maximum waiting period on pre-existing diseases is four years.

Pre-existing disease list

The list of pre-existing diseases includes:

  • Cancer
  • Diabetes
  • Sleep Apnea
  • High blood pressure
  • Asthma
  • Acne
  • Anxiety
  • Depression
  • Epilepsy
  • Lupus
  • COPD and more.


Detailed information available at Pre-existing disease, waiting period, and plans with low waiting period for PED.

Don’t forget to read - Pre-existing disease covered from Day 1

Having said that, let us discuss IRDAI.

IRDAI

Firstly, IRDAI stands for Insurance Regulatory Development Authority of India. IRDAI is an autonomous, statutory body that regulates and promotes the insurance and re-insurance industries in India.

As far as IRDAI functions are concerned, it is responsible for :

  • Protecting the interest of the policyholders and ensuring fair treatment to them.
  • Promoting fast and orderly growth of the insurance industry.
  • Setting, promoting, monitoring and enforcing high standards of integrity, financial stability, fair dealing and competence.
  • Ensuring quick settlement of genuine claims, preventing insurance frauds.
  • Taking action where standards are improper.
  • Registering companies running the insurance business.


That being said, let’s focus on -

The changes that IRDAI has made in the rules of pre-existing diseases for the benefit of policyholders.

According to IRDAI’s one of the latest circulars, dated February 10, 2020, diseases that have been diagnosed within the six months of policy issuance will not be treated as pre-existing diseases.

Earlier, illnesses diagnosed within three months of policy issuance were considered pre-existing illness, but IRDAI’s new modification has brought about a drastic change in the whole scenario.

As per IRDAI, these modifications will be included in the guidelines on standardization in medical insurance policies.

The prime motive behind this rule amendment is to make health insurance in India simple and more customer-friendly.

One of the biggest advantage of new pre-existing disease rule will be a massive reduction in health insurance claim rejection. In the past, had the policyholder developed a condition within 3 months of buying a policy, the claim would have been rejected. However, after this amendment, no such disease will be treated as PED, diagnosed even within 3 months or later of buying a health insurance policy.

Lastly, IRDAI has advised all insurance companies and third-party administrators to make the desired changes. Moreover, to ensure proper compliance, wherever applicable, with immediate effect.

Also Read

IRDAI Issues New Health Insurance Guidelines to Protect the Policyholders

A Complete Guide to Top-Up Health Insurance Plans!

In case of any questions regarding pre-existing disease coverage or IRDAI rules, feel free to contact InsuranceDekho experts at 18001205698.

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