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Health Insurance Pre-Existing Conditions

IRDAI Rules for Pre-Existing Diseases Cover

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About Pre-Existing Disease Cover Health Insurance

Health insurance is an armor that protects the policyholders from unforeseen medical emergencies. But, things are not rosy for individuals who have pre-existing diseases (PED). Some companies do not provide full coverage for pre-existing diseases or some have a long waiting period. However, the latest announcement of IRDAI (Insurance Regulatory Development Authority of India) came up with the good news for the insurance holders diagnosed with pre-existing conditions.

What are Health Insurance Pre-Existing Conditions?

Basically, health insurance pre-existing conditions are the illness, injury, or other condition that existed before the policy issuance. Diabetes, COPD, cancer, epilepsy, depression, anxiety, and sleep apnea some common examples of PED.

IRDAI Announcements on Health Insurance Pre-Existing Conditions

According to the new circular, the definition of "health insurance pre-existing conditions" has been changed and modified. Let's read more about health insurance pre-existing diseases, the new amendment by IRDAI, and how it is beneficial for pre-existing disease policyholders.

Health Insurance Pre-Existing Conditions Old vs New

Below is the difference between the old and the new definition of pre-existing diseases:

Old Definition of Pre-Existing Diseases

New Definition of Pre-Existing Diseases

That is diagnosed by any physician within 48 months, before the effective date of the policy issuance.

That is diagnosed by any physician within 48 months, before the effective date of the policy issuance.

For which medical advice or treatment was received from a physician within 48 months preceding the effective date of the policy or its reinstatement.

Any illness for which medical advice or treatment was recommended, or received from, a physician within 48 months preceding the effective date of the policy issued by the insurer or its reinstatement.

Any condition for which symptoms or signs if presented and have resulted within 3 months of the issuance of the policy in a diagnostic illness or medical condition.

According to the amendment IRDAI has deleted this clause.

Therefore, according to the new amendment, no disease or illness shall be considered as pre-existing disease if diagnosed within three months from the date of buying the policy.

Note: However, the modification in health insurance pre-existing conditions is not applicable to travel insurance.

How are Health Insurance Pre-Existing Conditions Beneficial for Policyholders?

It is a piece of good news for the policyholders who are suffering from pre-existing diseases. IRDAI has now deleted the additional/modified clause. See how it is beneficial for a policyholder:

  • It could lead to a reduction in unnecessary claim rejection by the insurer
  • It takes away most of the ambiguities in pre-existing diseases
  • Insured will disclose the true medical history
  • Insured with PED get more coverage
  • IRDAI advised all the health insurance companies and TPA (Third Party Administrators) to make the amendments with immediate effect and ensure compliance

Therefore, health insurance has now become a necessity. However, earlier for the people with pre-existing conditions it was difficult to get complete coverage. IRDAI initiative is really helpful for the people who cannot afford the on-going treatment of their pre-existing disease. Now even if they are diagnosed with such chronic diseases after buying a policy they will get the claim.

Trusted brands like Care Health Insurance (Formerly Religare Health Insurance) offers cashless health insurance plans to the people with pre-existing diseases so that they can avail the best possible treatment with maximum coverage and financial security.

Few Facts That You Must Be Aware of Before Buying Cover for Pre-existing Conditions

Each health insurance plan has different features and pre-requisite. Below are some facts that you must be aware of before buying pre-existing disease health insurance:

  • Health insurance with pre-existing conditions has a waiting period ranges from 24 months to 48 months.
  • Not every ailment is a pre-existing disease. There is a list of pre-existing diseases that are admissible for the claim under the health insurance coverage.
  • Look for health insurance plans with a low waiting period so that your pre-existing illnesses get covered at the earliest.
  • Opt for a health insurance policy at a young age so that you can wait out the applicable waiting period to avail the coverage when any illnesses develop.
  • Premium for pre-existing disease health insurance will be on the higher side. It is so because we are taking the risk of covering a pre-existing disease. Such premium loading is only applicable at the time of purchasing the policy

Things to Remember if you Have a Pre-Existing Medical Condition

If you have a pre-existing medical condition, you should remember the below things to avail the maximum benefit out of the pre-existing disease health insurance:

  • Minor health issues such as cough, cold, and fever are not pre-existing diseases.
  • Never hide your medical condition that affects your chances of getting a health insurance policy or also claim rejection if any pre-existing condition is found later. 
  • Pre-policy medical check-up for pre-existing disease
  • Reduction in wait period for pre-existing diseases is an add-on benefit that you can get if you opt for Care-our comprehensive health insurance policy

Earlier, it was difficult for people with pre-existing conditions to get complete coverage. IRDAI initiative is beneficial for those who cannot afford the on-going treatment of their pre-existing disease. We offer cashless health insurance plans to people with pre-existing diseases. These plans help them to avail the best possible treatment with maximum coverage without financial stress.

FAQs

How are pre-existing conditions determined?

The diseases, injury, and other medical conditions that existed before the policy issuance is called the pre-existing conditions. These are diagnosed by any physician within 48 months, before the effective date of the policy issuance.

Can I be denied health insurance if I have a pre-existing condition?

You can avail of health insurance if you have a pre-existing condition. However, underwriting of claims for pre-existing diseases is subject to policy terms and conditions. 

Could my health plan have a pre-existing condition waiting period?

Yes, your health plan has a pre-existing condition waiting period. However, you can choose a reduction in the wait period add-on cover offered by us. The waiting period will be reduced from 48 months to 24 months, subject to policy terms and conditions.

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