Clearing The Air Over Pre-Existing Diseases

There were three sets of regulations issued by IRDAI in September with respect to health insurance.

- RAJALAKSHMI NIRMAL

One of them, the ‘Modification Guidelines on Standardisation in Health Insurance’, listed items on which health insurers can give optional covers and, more importantly, amended the definition of pre-existing diseases as given in the original guideline issued in July 2016. The new guideline is applicable to all health insurance products filed here on.

A look at the changes.

Old definition

Pre-existing diseases (PED) refer to medical conditions or diseases that an individual had suffered from before buying the insurance. In the old guideline, it was defined as“any condition, ailment or injury or related condition(s) for which there were signs or symptoms, and/or were diagnosed, and/or for which medical advice/treatment was received within 48 months prior to the first policy issued by the insurer and renewed continuously thereafter”.

The problem here is that it leaves many loose ends unaddressed. One, the term ‘related condition’ is vague. There is no clear indication as to what it actually refers to. Second, going by the definition, all conditions for which the person had signs/symptoms in the 48 months prior to taking the policy, were considered PED.

New definition