The Insurance Regulator and Development Authority of India (IRDAI) has brought in changes to the definition of pre-existing diseases. Through a circular dated February 10, 2020, IRDAI has deleted ‘the additional/modified clause’ in its current definition of pre-existing diseases. Experts say this move could bring in a reduction in the claim rejection rates in health insurance policies.

The regulator had modified the definition of pre-existing diseases last year. IRDAI had included certain illnesses if they were diagnosed within 3 months after purchasing the health insurance policy. However, as per the new definition, now no such disease will be treated as a pre-existing disease even if diagnosed within 3 months, or later, of buying the health insurance policy.

Definition of Pre-existing Diseases as per IRDAI

The existing definition of Pre-Existing Disease sates that (not applicable for Overseas Travel Insurance) pre-existing disease means any condition, ailment, injury or disease:

i) Old definition: That is diagnosed by any physician within 48 months, preceding the effective date of the policy issued by the insurer.

New definition: That is diagnosed by a physician within 48 months preceding the effective date of the policy issued by the insurer or its reinstatement.

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

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

iii) Old definition: 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.

New definition: Deleted

What is pre-existing condition?

Insurance companies consider medical illness or injury that have occurred to the policyholder before he/she started a new health plan as a pre-existing condition.

Examples of pre-existing health conditions

Conditions like diabetes, COPD, cancer, lupus, epilepsy, depression, anxiety, sleep apnea, etc. fall under pre-existing health conditions, mostly which tend to be chronic or long term.