What are the Revised Rules for Pre-Existing Diseases as per IRDAI?

The importance of health insurance is reiterated by many. No age is too late to purchase medical cover. Health ailments can strike at most inopportune times and can lead to a debt-trap if not planned. This is when health insurance comes to the rescue, helping you stay at peace, both mentally and financially.

Periodically, the regulatory body, The Insurance and Regulatory and Development Authority of India (IRDAI) makes necessary modifications to streamline the insurance process in the interest of insurers, as well as policyholders. One such modification is regarding the definition of pre-existing diseases along with standardized health insurance plans and access to blacklisted hospitals.

What is a pre-existing disease?

Pre-existing diseases or PED is the medical condition, ailment, or injury that the insured already has contracted at the time of buying health insurance plans. These health ailments which already exist when purchasing an insurance cover are included or specifically excluded under your policy depending on the terms and conditions specified by the insurer.

Do pre-existing diseases impact your premium?

Yes, PEDs have an impact on your premium as well as bring a waiting period along with them.

When a waiting period is applicable, the insurance company may cover such PED but only after a specified duration. Any treatment costs that are incurred during such waiting period tenure are excluded by your insurer.

In some scenarios, the insurance companies provide instant coverage for your pre-existing ailment. During such times, the instant coverage is compensated by a loading to your premium amount. Despite higher premiums, the insured is still at an advantage due to the broad cover available under your insurance plan. Hefty hospitalisation bills are covered by your insurer as per specified terms to your policy. You must note that your premiums can be loaded only for pre-existing diseases. Any disease that occurs after the policy is issued and renewed without breaks cannot be loaded for PEDs.

In some cases, critical ailments bring a loading in premium as well as waiting period in your policy tenure. Diseases like cancer, HIV, etc. are excluded from most standard plans and opting for critical illness insurance can be helpful to insure against them.

What are the revised rules for pre-existing diseases?

The definition of pre-existing diseases was modified recently to clear the ambiguity involved. Pre-existing diseases are now defined as medical conditions that are diagnosed or for which treatment is recommended 48 months before purchasing the policy.

The earlier amended definition included the clause as follows-

A condition for which any symptoms and or signs if presented and have resulted within three months of the issuance of the policy in a diagnostic illness or medical condition.

The above clause now stands deleted as of February 2020.

These are the revised rules for PED. Make sure you are well informed of these rules when buying health insurance for senior citizens as this is the age where most times one might be suffering from a health condition at the time of opting a health cover.

Post Author: Lailah Ford