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Good news for health insurance customers. 🎉
1/n Health Insurance customers have always been wary of the definition of pre-existing disease in health insurance policies. And why not, it has been a grey area where many claims are declined to the dissatisfaction of thousands.
2/n With continuing standardization, IRDAI has gradually simplified the pre-existing disease definition, by removing vague wordings. This will help customers understand the policy better, and reduce claims related grievances.
Here's how the definition has changed since 2016.
3/n Here's the definition from July 2016. It was too wide and vague - included "signs", "symptoms", whether the disease was diagnosed or not, whether medical advice received or not.
4/n For eg, Mr X had signs of heart disease but never recd medical advice. Mths later he buys health insurance. 3 yrs later, he is diagnosed with heart disease, undergoes surgery. The claim may get declined on grounds that Mr X had signs of the disease before policy was issued.
5/n Then it evolved into a more objective definition, putting a time limit on the recognition of pre-existing signs and symptoms as the pre-existing disease after the policy is issued.
6/n In the same scenario above, Mr X will get his claim, as the diagnosis of the symptom into illness happened after 3months of issuance of the policy.
On the other hand, if he had to undergo surgery within 3 mths of the issuance of the policy, the claim would be declined.
7/n The recent update removes the entire symptom/signs condition from the definition. #win
Now the condition should be *diagnosed* or *medical advice received* from a medical professional prior to the issuance of the policy for it to be considered pre-existing h
9/n Now, if you are buying health insurance, all you need to do is ensure that if you have been *diagnosed* have taken *treatment* or *advice* for any disease for you, your family, declare it in the proposal form.
There is no impact on people who already own a health insurance.
8/n Which means even if Mr X was diagnosed for heart disease within 3 months of the issuance of the policy (for a symptom that existed before buying the policy), he will still be paid the claim on the policy for any hospitalization treatment that is advised. #win
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