In a bid to make health insurance more simple and customer-friendly, the insurance regulator recently amended the definition of pre-existing diseases. The Insurance Regulator and Development Authority of India (IRDAI) said in circular that it deleted ‘the additional/modified clause’ in its current definition of pre-existing diseases. This move could actually help in reducing claim rejection rates in health insurance policies.

To include certain illness under health insurance policy, the regulator had modified the definition of pre-existing disease through a circular in September, 2019. 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, said IRDAI. 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. The regulator also mentioned that the modification will be included in the guidelines on standardisation in health insurance policies.

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, anxiety are considered as pre-existing health conditions.

IRDAI also modified the existing definitions of pre-exiting diseases that are not applicable for overseas travel insurance. Here are the changes

Pre-existing disease means any condition, ailment, injury or disease:

Old definition: The illnesses that are diagnosed by a physician within 48 months prior to the effective date of the policy issued by the insurer.

New definition: The illnesses that are diagnosed by a physician within 48 months prior to the effective date of the policy issued by the insurer or its reinstatement.

Old definition: 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.

New definition: 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

All the insurers and third-party administrators are advised to make a the changes and ensure compliance, wherever applicable, with immediate effect, said IRDAI.

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