The insurance regulator, IRDAI has modified some of the rules regarding pre-existing diseases that would benefit policyholders. These changes have made the definitions of pre-existing disease clear about the ambiguities that could have lead to claim rejection and termination of policies.
Earlier, the Insurance Regulatory and Development Authority of India (IRDAI) has changed this definition of pre-existing diseases two times. As per the latest rules, if within the first three months of the policy, a policyholder is diagnosed with any disease, it will not be considered as pre-existing disease.
“This change takes away problems that policyholders could have faced due to existing regulations. If an illness falls under the definition of pre-existing disease, the insurer could reject the claim, hike premium, or even terminate the policy,” said Amit Chhabra, head – health insurance, Policybazaar.com, an online insurance marketplace.
There are two types of pre-existing diseases. The first one is when the policy holder takes the policy and he had illness already. If an individual had a disease 48 months before buying a health insurance plan, it is called as pre-existing, even if it was treated.
Changes have been made to the second tyep of the pre existing deseases, as per which any illness that an insured get within the three months of taking the policy; it will be considered as a pre-existing disease.
The waiting period is four years for the pre-existing disease. But it may vary from one insurer to another and also depending on their disease. “The problem is that each insurance company deals with pre-existing disease differently. Some may reject a claim, some may charge an extra premium, some may even terminate the policy if they feel that the risk is too high,” said Chhabra.