IRDAI Reduces Waiting Period for Pre-Existing Diseases in Health Insurance Policies
"New Health Insurance Rules: Individuals Over 65 Eligible to Purchase Policies"
New Delhi: In a significant development for health insurance consumers in the fiscal year 2024-25, the insurance regulator has announced a reduction in the maximum waiting period for pre-existing diseases (PEDs) such as hypertension, diabetes, thyroid issues, and knee surgeries. Effective from April 1, the waiting period has been reduced from 48 months to 36 months.
The Insurance Regulatory and Development Authority of India (IRDAI) clarified that while there’s no upper limit on the waiting period, insurance companies can opt for a lesser waiting period. A government official, speaking on condition of anonymity, shared this information.
The waiting period in health insurance policies denotes the duration before specific diseases are covered by the policy. PED refers to ailments existing before the purchase of the health insurance policy.
Amidst fierce competition in the sector, many companies already offer policies with a two-year waiting period or even less for certain diseases. However, experts suggest that IRDAI’s recent notification might prompt further reductions in waiting times.
According to the notification by IRDAI, the waiting period for disclosed pre-existing diseases shall not exceed 36 months of continuous coverage under the health insurance policy. Insurers are encouraged to aim for shorter waiting periods and specific waiting periods in their health insurance products.
The new definition specifies PED as “any condition, ailment, injury, or disease diagnosed by a physician within 36 months prior to the policy’s commencement date.” It also includes conditions for which medical advice or treatment was recommended or received within the same period.
The specific waiting period, up to 36 months from the policy’s commencement, excludes specified diseases due to accidents. Upon completion of this period, the diseases or treatments will be covered, provided the policy has been continuously renewed without interruption.
The revised waiting period for pre-existing diseases will apply to all new health insurance policies and renewals from April 1, according to experts. This move aims to streamline the development of innovative insurance products without compromising policyholder interests. It aligns with efforts to enhance governance standards in the insurance ecosystem.
