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Naveenn Kummar |228 Answers |Ask -Follow

Financial Planner, MF, Insurance Expert - Answered on Sep 11, 2025

Naveenn Kummar has over 16 years of experience in banking and financial services.
He is an Association of Mutual Funds in India (AMFI)-registered mutual fund distributor, an Insurance Regulatory and Development Authority of India (IRDAI)-licensed insurance advisor and a qualified personal finance professional (QPFP) certified by Network FP.
An engineering graduate with an MBA in management, he leads Alenova Financial Services under Vadula Consultancy Services, offering solutions in mutual funds, insurance, retirement planning and wealth management.... more

Question by Ajay on Sep 09, 2025Hindi

My wife has SLE as pre existing desses,I am searching for mediclaim policy which covers SLE

Ans: Dear Sir,

Thanks for your question. Systemic Lupus Erythematosus (SLE) is a serious pre-existing autoimmune disease. Finding a mediclaim policy that covers SLE (or covers it with reasonable terms) is possible, but you must be very careful in selecting the insurer and policy wording. Here’s what you need to know + some options and suggestions.
What IRDAI / Regulations Say

IRDAI defines PED as an illness which the insured was diagnosed or received treatment for in the 48 months before policy start.

Newer rules require transparency and clarity in policy documents and disallow certain unfair exclusions.
What Might Happen / What Limits to Expect

Even with a policy that covers SLE, some treatments (especially high-cost biologics, long-term immunosuppressive therapy) may have waiting periods, sub-limits, co-payments, or exclusion riders.

There may be premium loading (you’ll pay more).

Some day-care procedures, or outpatient treatments (OPD), or specific complications might not be covered or might require separate riders.

If diagnosed recently, the waiting period may be longer or insurer may refuse initially.

Suggested Plan of Action

Here’s what I suggest you do step by step:

Disclosure: When applying, clearly disclose diagnosis date, medication, any hospitalisations. Be honest.

Get Written Quotes: Ask the insurer in writing about SLE-specific coverage: waiting period, what parts of treatment will be covered, what will be excluded.

Compare Sum Insured vs Premium: Choose a policy with adequate sum insured because autoimmune diseases can need frequent hospitalisation.

Consider Riders / Critical Illness Cover: Sometimes a Critical Illness Rider that explicitly covers SLE or its complications is helpful.

Maintain Policy Continuously: Do not let renewal lapse. Gaps can lead to loss of continuity and waiting period resets.

Keep Medical Records: Keep copies of all diagnosis, treatment, doctor’s reports etc. These help during claim.

Consult IRDAI or Ombudsman If Claim Denied: If insurer rejects legitimate claim, you can escalate.

Best regards,
Naveenn Kummar, BE, MBA, QPFP
Chief Financial Planner | AMFI Registered MFD
https://members.networkfp.com/member/naveenkumarreddy-vadula-chennai

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