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By IRDAI’s definition, a pre-existing condition pertains to any condition or disease that has occurred in the 48 months prior to issue of the policy; the older fully cured conditions/diseases lie outside this definition and, hence, cannot be considered as ‘pre-existing’ conditions/diseases. Am I right?
So, in the case of an older condition/disease which is fully cured, can I claim that I have no pre-existing condition/disease in the application form; or in case I declare such an old condition, is the insurer entitled to refuse issuance of a new policy to me, considering it to be a pre-existing condition? Also, is there any specific rule in the IRDAI policy that gives the insurer the right to such a refusal?
Dinanath Sawant
It is right that only diseases/conditions that have occurred in the 48 months prior to taking up the health insurance policy are considered as ‘pre-existing’ and need to be disclosed at the time of buying the policy.
However, it is safe to disclose even those ailments for which you have received treatment and were cured before five or 10 years, especially if it’s a serious condition such as cancer or a heart ailment. This can avert a claim rejection later.
Generally, insurers ask prospective customers to fill a disclosure form on health conditions when issuing a policy. While some ask only about pre-existing conditions that were diagnosed 48 months prior to buying the policy, others have an open question where in you will have to mention any illness suffered at any time in your life.
In such a case, even if it is a minor condition, say, thyroid dysfunction for which you received treatment, you need to disclose it. The insurer will use the information to underwrite the policy. There is no rule from the regulator that says pre-existing diseases — the conditions that occurred in the immediate 48 months before policy issuance — should only be taken into account while underwriting a policy. Some insurers consider even those outside the purview of pre-existing diseases, and decide on issuing/rejecting the policy and its premium.
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