Health Insurance
Compare Health Insurance offered by all general insuance companies to help you decide the plan which suits you the best.
Health Insurance: Coverage
The pre-existing disease syndrome affects the spread of health insurance in India. IRDA measures can revolutionise the sector.
Ever since the mediclaim policies were introduced in the 1980s, the biggest bone of contention between the insurance companies and the consumers has been the issue of pre-existing disease.
So, what exactly is meant by pre-existing disease? Well in most mediclaim policies it is defined as any disease that the consumer had (whether he was aware of it or not) at any time prior to the commencement of the policy with the insurance company and it also includes any complications arising in the future from such pre-existing disease. Most consumers are normally not aware about is the 2nd leg of the definition (about complications arising from the pre-existing disease). Since the most common pre-existing diseases in India are diabetes and high blood pressure (hyper tension) and these are responsible for a wide spectrum of serious diseases such as heart blockages, organ failure, etc. etc. the consumers are taken aback when the insurance companies deny payment of claim on grounds that these diseases arose from an pre-existing condition and hence will be classified as an pre-existing disease.
It was to avoid these issues that the General Insurance Council which is a statutory body of all general insurance companies in India under the Indian Insurance Act, 1938 came up with common wordings in respect of pre-existing diseases that was supposed to apply for all policies issued from June 1, 2008.
Firstly the definition of Pre-existing disease was restricted to Any condition, ailment or injury or related condition(s) for which you had signs or symptoms, and / or were diagnosed, and / or received medical advice/ treatment, within 48 months prior to your first policy with us. Clearly it did not include any future complications arising from a pre-existing condition as well as restricted the pre-existing definition to only those conditions that arose in 4 years before the commencement of the policy (and not, as is usually defined, at any time before the commencement of the policy). Although this is a statutory body of the general insurance companies themselves it is surprising that not a single general insurance company has adopted this definition of pre-existing disease.
The same resolution also went on to provide that Benefits will not be available for any pre-existing condition(s) as defined in the policy, until 48 months of continuous coverage have elapsed, since inception of the first policy with us essentially meaning that even these pre-existing conditions will be covered in the 5th continuous renewal.