Issuing clarification on the definition of pre-existing disease,not applicable for Overseas Travel Insurance, the insurance regulator IRDAI has said that it would mean any condition,ailment, injury or disease that is/are diagnosed by a physician within 48 months prior to the effective date of the policy issued by the insurer or its reinstatement.
It would also include medical advice or treatment which was recommended by, or received from, a physician within 48 months prior to the effective date of the policy issued by the insurer or its reinstatement.
The regulator has scrapped the existing norms that says pre-existing disease can incude conditions for which any symptoms and or signs if presented and have resulted within three months of the issuance of the policy in a diagnostic illness or medical condition.
IRDAI wants expenses incurred towards treatment in any hospital or by any medical practitioner or any other provider are specifically excluded by the insurer and disclosed in its website / notified to the policyholders are not admissible.
However, in case of life threatening situations or following an accident, expenses up to the stage of stabilization are payable but not the complete claim.
IRDAI has explained that details of excluded providers will be given with the policy document. Insurers to use various means of communication to notify the policyholders, such as e-mail, SMS about the updated list being uploaded in the website.
The insurance regulator has outlined the exclusion of expenses related to sterility and infertility. This includes:
– Any type of contraception, sterilisation,
– Assisted Reproduction services including artificial insemination and advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI,
– Gestational Surrogacy,
– Reversal of sterilisation