Pre-existing diseases rule would be modified by IRDAI. All the insurers and third party administrators are advised to make the changes with immediate effect. With the aim 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 Health insurance new rule .

The regulator had modified the of pre-existing disease to include certain illnesses under health insurance policy. 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 standardization 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.

Insurance Regulatory and Development Authority of India (IRDAI) has also brought several changes and modified the existing definitions of pre-existing 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.