Health insurance is beneficial in difficult scenarios such as medical emergencies. Nonetheless, this is achievable only if the details provided by you and the company in the health insurance policy are clear.

Without clear evidence, insurance firms deny the claim. One of these pieces of information is… pre-existing conditions (PEC). PED is an abbreviation for… Any health issue, ailment, or injury that was addressed or whose symptoms existed prior to your acquisition of a health insurance policy. Existing health conditions significantly impact the evaluation of risk and the conditions of coverage.

IRDAI Rule

According to the rules set by the Insurance Regulatory and Development Authority of India (IRDAI), any medical issue treated 48 months prior to purchasing a health insurance policy is classified as a pre-existing disease, or PED. These encompass long-term conditions such as diabetes, hypertension, asthma, along with any surgeries or treatments that occurred earlier. If an individual received treatment for hypertension 48 months prior to purchasing a health insurance policy, it would be classified as a PED.

If someone underwent a knee surgery three years prior, it too would qualify as a PED. As per IRDA, if an individual underwent an appendix surgery 10 years prior and has not encountered any issues in the past 48 months or required medication for it, then it won’t be classified as PED in the context of insurance risk evaluation.

“Even if you believe that your situation is managed with medications or therapy, it is still regarded as a PED. Submitting inaccurate details in the policy application constitutes a violation of the insurance agreement and may result in legal issues. The insurance provider is entitled to examine the claims. Identifying pre-existing conditions can result in additional losses beyond just the denial of the claim”, said Bhaskar Nerurkar Head, Health Administration Team.