IRDAI Introduces New Changes In Health Insurance Policies

The Insurance Regulatory and Development Authority of India (IRDAI) has amended the definition of pre-existing diseases (PED), which is likely to reduce the rate of claim rejection in health insurance. Find the circular here.

What does this mean for policyholders?

According to the new change, any disease that a policyholder gets diagnosed with within the first three months of taking a health insurance policy will no longer be considered as a PED.

Pre-Existing Diseases
  • Any medical illness or injury that has occurred to the policyholder before they start a new health plan is considered as pre-existing disease by insurance companies.
  • If a person is diagnosed with a disease only three months after buying a health insurance policy, it is considered as a pre-existing illness.
  • Diabetes, cancer, anxiety, depression, lupus, sleep apnea all are considered as pre-existing conditions.
  • Most of these conditions are chronic and long term in nature.
The Previous Circular
  • IRDAI had issued a circular in September 2019, according to which if the policyholder has certain illnesses that were diagnosed within three months of buying the health insurance policy, then that would be considered as pre-existing diseases.
  • However, now in the latest circular issued, no such conditions will be treated as pre-existing diseases even if diagnosed within three months, or later, after purchasing the health insurance.
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