IRDA modifies the definition of pre-existing diseases

Dashmeet Kaur | Updated: Feb 29, 2020 | Category: IRDA Advisory

Recently, Insurance Regulator and Development Authority of India have released a circular which omits the additional/modified clause in its existing definition of pre-existing diseases. IRDA modifies the definition of pre-existing diseases to reduce the claim rejection rates in Health Insurance Policies and provide a customer-friendly experience.

Previously in September, IRDA had amended the definition of pre-existing diseases to include some illness under the policy of Health Insurance. As per that, if certain illnesses are diagnosed within three months of purchasing the health insurance policy, then it will be considered as pre-existing diseases. Thus, it shall be covered under the Insurance Policy. IRDA released the definition under the guidelines of standardization in Health Insurance on 27th September 2019. However, the latest circular has completely revamped the definition. According to it, no such diseases shall be treated as pre-existing diseases even if diagnosed within 3 months or after purchasing the Health Insurance Policy [1] .

Insurance Regulatory and Development Authority of India has initiated a step to constitute a committee that will rationalize and standardize exclusions in Health Policy. The latest circular provides a clear definition of pre-existing diseases. It states that pre-existing disease is an ailment, injury or condition that already exists at the time of purchasing an Insurance Policy. Illness such as Diabetes, Lupus, Epilepsy, Depression, Anxiety, Sleep apnea shall be considered as pre-existing health conditions. Such a move will bring a positive change in regards to policyholders as it removes any ambiguity.

Modification in the old definition of pre-existing diseases

The changes made by IRDAI in the current definition of pre-existing diseases do not apply for Overseas Travel Insurance. Here are the changes:

Old Definition	New Definition
Pre-existing disease refers to any condition, injury, ailment or disease	Pre-existing disease refers to any condition, injury, ailment or disease
It is diagnosed by a Physician within 48 months before the effective date of Policy issuance by the Insurer	It is diagnosed by a physician within 48 months before the effective date of policy issuance by the insurer
Medical advice/treatment was recommended or received from/by a physician within 48 months before the effective date of the policy or its reinstatement	Medical advice/treatment was recommended or received from/by a physician within 48 months before the effective date of the policy or its reinstatement
A condition where any sign or symptom if presented and resulted within three months of the Policy issuance in a diagnostic illness/medical condition	This clause has been deleted
Life insurers may define for applicability of pre-existing diseases at reinstatement	Life insurers may define for applicability of pre-existing diseases at reinstatement

The new definition of pre-existing disease is a condition, injury or ailment that already exists at the time you buy an Insurance Policy. IRDA excludes such diseases from Health Insurance Policy coverage for a waiting period of four years.

All the Insurance providers and third-party administrators must ensure compliance with the immediate effect of IRDAI’s new amendment.

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Dashmeet Kaur

Dashmeet Kaur is an experienced content writer, having proficiency in writing Legitimate content with comprehensive research. She also has a keen eye to detail and incorporating accurate facts.