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Articles 3354 views February 14, 2020
Health Insurance is one of the most significant investments. It helps in availing proper treatment at the right time without being at risk of bearing the cost of medical treatment. With the right health insurance policy, you can face enormous medical expenses. However, all health insurance policies come with certain terms and conditions. A pre-existing medical condition is one such criterion where the health insurance provider sets specific terms. We all know that health insurance providers provide health insurance policies to individuals ailing from certain pre-existing diseases.
However, the waiting period is one crucial aspect which causes a hitch, it does not let the assured to avail the benefits of his/her health insurance policy until the waiting period is over.
So, to overcome this hitch, the Insurance Regulatory and Development Authority of India (IRDA), is all set to change the tone. The insurance regulator has recently amended the definition of ‘pre-existing diseases. This move by IRDA to change the definition is expected to reduce the rate of health insurance claim rejections.
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The original definition describes pre-existing disease (PED) as the terminology used to refer a particular medical condition, injury or ailment, that existed when the policyholder purchased the health insurance policy. An insurance provider usually excludes PED from the scope of insurance cover until the completion of the initial waiting period. This waiting period ranges from 2 years to 4 years.
The IRDA has brought in 2 amendments in the original definition with an intent to widen the scope of insurance coverage for individuals ailing with PED and to reduce the rate of health insurance claim rejection. The two amendments done by IRDA are as under:
The new definition of pre-existing disease has deleted the following clause related to PED in the old definition:
The pre-existing disease is any condition, ailment, injury, or disease for which any symptom and signs if presented are leading to an illness or disease within less than 3 months of issuance of the policy. Also, one of the most important aspects of pre-existing disease is that it does not apply to overseas travel insurance.
With the recent change in the definition of pre-existing disease, IRDA has silently issued a tab on the health insurance companies. Owing to the earlier definition of PEDs the health insurance providers were rejecting insurance claim and even the waiting period was creating a hindrance for insurance cover. So even after paying a hefty premium amount, the claim rejection rate was high. However, the recent move could undoubtedly reduce the rate of health insurance claim rejection.
Additionally, the IRDAI has stated in its new directive, has advised all insurance providers, third-party administrators (TPAs), insurance agents, and brokers, wherever applicable, to make necessary changes and ensure complete compliance of new directive with immediate effect.
The following are certain things that every prospective policyholder must keep in mind:
Health insurance is an important investment. Ensure that you know and understand the terms and conditions as well as inclusions and exclusions of the policy. Do not forget to be transparent to the insurance provider.