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Over the past few years, the health insurance policies in India have evolved significantly. The Insurance regulatory body in India, the IRDA (Insurance Regulatory and Development Authority), has taken many steps to make the policies more beneficial for the policyholders.The IRDA issued a circular to all the insurers in India regarding the pre-existing diseases definition amendment and advised all insurance companies and Third Party Administrators (TPA) to make the changes with immediate effect.The IRDA has removed the term 'the additional/modified clause' from the current definition of the pre-existing disease. Many insurance experts suggest that the amendment introduced by IRDA is an excellent move to make the policy simple for the customers. It clarifies the ambiguity that leads to rejection of policy claims and, in some cases, the policy's termination.In September 2019, the IRDA issued a circular, which stated that the illness diagnosed within three months of issuing the policy would be considered a pre-existing disease and would be covered under the policy. However, in its latest circular issued in February 2020, the IRDA specified that all illnesses that are diagnosed within six months of the policy issuance would not be treated as a pre-existing condition. The regulatory body also mentioned certain modifications in the guidelines on the standardisation of the medical insurance policies.The pre-existing disease is a condition or an ailment that already exists at the time of buying a health insurance policy . Conditions like sleep apnea, diabetes, epilepsy are considered pre-existing conditions.In its circular, the IRDA further specified that to address the claim rejection issue due to the grey areas in the definition of pre-existing diseases; it has changed the definition altogether. The new rules now define pre-existing illness as 'a condition that is diagnosed by a physician within 48 hours before the effective date of the policy issued by the insurer or its reinstatement, or 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.
DISCLAIMER
The information contained herein is generic in nature and is meant for educational purposes only. Nothing here is to be construed as an investment or financial or taxation advice nor to be considered as an invitation or solicitation or advertisement for any financial product. Readers are advised to exercise discretion and should seek independent professional advice prior to making any investment decision in relation to any financial product. Aditya Birla Capital Group is not liable for any decision arising out of the use of this information.
