IRDA modifies the definition of pre-existing diseases

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.

Alaso, Read:Process of Appointment of Principal Officer for Insurance Web Aggregator

docsbizkit
 

Related Articles

Requirements for Insurance Broker License
Shivi Gupta
| Date: Jun 17, 2020 | Category: Insurance Broker

Insurance Broker Educational Requirements for Insurance Broker License

The insurance sector in India is rapidly developing and moving towards a more transparent and accessible market for insurance buyers. Insurance businesses that operate in India include insurance companies, web...

Read More
Functions of Web Aggregators
Dashmeet Kaur
| Date: Jan 29, 2020 | Category: IRDA Advisory

What are the Fundamental Functions of Web Aggregators?

Nowadays, security is the biggest concern of every individual. Therefore, people often depend upon insurance policies and services. Several insurance companies assure to provide a supreme level of protection but...

Read More
Documents for Insurance Broker License
Shivani Jain
| Date: Dec 04, 2020 | Category: Insurance Broker

What are the Documents Needed to obtain Insurance Broker License in India?

Today, a wide range of insurance products are available in the financial market. As a result, a layperson with no financial knowledge or background gets confused regarding the right insurance...

Read More

ARTICLES

Hi! My name is Akanksha! Let's talk.