Prevalence of a pre-existing disease is one of the main reasons why a health insurance claim gets rejected. Most health insurance policies come with a waiting period on pre-existing ailments to avoid fraud or adverse selection. From an insurance standpoint, this seems fair as insurance is about covering a risk and not an eventuality, but most often customers end up with the short end of the stick. That’s because it is loosely defined. The definition of a pre-existing ailment is open to wide interpretation that favours the insurers, but this may change.
That’s because the latest report by the Insurance Regulatory and Development Authority of India (Irdai) recommends a much sharper definition of a pre-existing ailment. The regulator constituted a working group in July 2018 to look into standardising and simplifying exclusions in health insurance contracts. The group’s report was published earlier this month.
