1. Understanding Pre-existing Diseases (PEDs) Pre-existing diseases refer to medical conditions that a person is already diagnosed with or shows symptoms of before purchasing a health insurance policy. Common examples include:

• Diabetes

• Hypertension

• Asthma

• Thyroid disorders

• Heart conditions

Importance of PEDs in Health Insurance Insurers are cautious about PEDs because they pose a higher risk of claims. Hence, such conditions typically come with:

• Waiting periods

• Premium loading

• Exclusions (in some cases)

2. What Has Changed in 2025? The IRDAI’s recent push towards more customer-centric regulations has brought the following key changes:

a) Standardization of Waiting Periods

Previously, insurers could impose waiting periods ranging from 2 to 4 years for PEDs. In 2025, IRDAI has mandated that:

• Maximum waiting period for pre-existing diseases should not exceed 36 months (3 years) for any retail health insurance plan.

• After 3 years of continuous coverage, all pre-existing conditions must be covered without any additional conditions.

This creates consistency and predictability for policyholders.

b) Transparent Underwriting

Insurers must now disclose underwriting decisions clearly. This means:

• Clear reasons must be given if coverage is denied or if loading is applied.

• Policy documents must include an annexure detailing PEDs declared and how they are treated in the policy.

c) Enhanced Portability

In 2025, policyholders can now carry forward their PED waiting period benefit when switching insurers, provided they maintain continuity:

• Example: If you completed 2 years of waiting with Insurer A and switch to Insurer B, only 1 more year is required.

This change promotes competition among insurers and benefits the customer.

d) Reduction in Disease List under PED

Some insurers had broad definitions of PEDs. Now, IRDAI has directed companies to limit what they classify as PEDs and avoid vague terms like “any condition with symptoms.”

e) Technological Integration for Underwriting

AI-based medical underwriting and digital health records (like NDHM) are now being used to assess risk more accurately and reduce unnecessary exclusions.

3. Impact on Policyholders These changes have multiple benefits for customers:

a) Easier Access to Coverage

People with common chronic illnesses can now buy insurance with reduced waiting periods and more transparency.

b) Lower Risk of Claim Rejection

Earlier, vague PED definitions led to claim denials. With clear disclosures and guidelines, the chances of rejections have dropped.

c) Competitive Premiums

With better regulation, insurers are now offering PED-inclusive policies at more reasonable premiums without excessive loading.

d) More Confidence in Portability

Consumers can now switch insurers freely without worrying about losing PED benefits.

4. Tips for Choosing the Right Policy in 2025

a) Disclose Honestly

Always disclose your medical history truthfully. Concealing PEDs can lead to claim denial.

b) Check Waiting Period Clauses

Compare waiting periods across insurers. Even though 3 years is the max, some policies may still offer 1 or 2 years.

c) Opt for Plans with PED Coverage from Day 1 (If Available)

Some premium plans now offer Day-1 PED coverage, especially for lifestyle diseases. Evaluate these if you have existing health issues.

d) Review Portability Benefits

If you’re switching policies, ensure that the new insurer acknowledges your continuity.

e) Monitor Technological Integrations

Choose insurers offering health monitoring apps, online claim intimation, and NDHM-linked records for better service.

5. Common Myths About PEDs in Health Insurance

Myth 1: You Can’t Get Insurance If You Have a Pre-existing Disease

Reality: You can. It may come with a waiting period or higher premium, but outright denial is now rare.

Myth 2: All Diseases Diagnosed Before Policy Are PEDs

Reality: Only conditions diagnosed or with clear symptoms before the policy date are counted.

Myth 3: PEDs Are Covered Only After 4 Years

Reality: As of 2025, it’s 3 years max. Some plans may cover them sooner.

Myth 4: PED Coverage Means Free Treatment Always

Reality: Coverage is subject to sub-limits, co-payments, and network hospital rules. Read fine print.

6. What Insurers Are Doing Differently in 2025

• Introducing Chronic Care Riders: Add-ons that offer regular check-ups, medicine delivery, and even wellness coaching.

• Incentivizing Health Goals: Discounts on renewal premiums for managing diabetes, BP, etc.

• Tailored PED Plans: Insurers are designing condition-specific plans (e.g., for diabetes or cardiac patients).

• Family PED Bundles: Group policies that cover common hereditary PEDs across family members.

Conclusion 2025 marks a significant leap in how health insurance treats pre-existing diseases in India. Thanks to proactive regulation by IRDAI, policyholders now enjoy greater clarity, reduced waiting periods, and improved portability. While insurance can’t eliminate illness, it can surely ease the financial burden if chosen wisely.

Whether you’re buying health insurance for the first time or reviewing an old policy, understanding how PEDs are handled is crucial. Make informed choices, ask the right questions, and always read the policy document carefully.