Are pre-existing diseases considered exclusions?

What is a Pre-Existing Disease under Health Insurance?

A pre-existing disease is a condition that the policyholder has been experiencing before applying for a health insurance plan. Some common examples of such diseases are asthma, thyroid disease, diabetes, and high blood pressure. Any diagnosis made within 48 months before purchasing the health insurance is considered a pre-existing condition. Such conditions are a part of exclusions in health insurance, at least for a time period. 

When applying for health insurance, the insurance company assesses the applicant's health conditions, and if a pre-existing disease is found, the coverage, premium, and waiting periods are determined accordingly.

Waiting Period for PED: What Should You Know

Purchasing a health insurance plan for a pre-existing condition is challenging primarily due to the waiting period. A waiting period for pre-existing diseases is the duration that the policyholder must wait before becoming eligible to raise any claims or utilise the benefits under the health insurance plan.
The waiting period is calculated from the date of policy issuance and ends according to the respective health insurance company's guidelines.

Let’s take a quick look at the types of waiting period:

1.Pre-Existing Diseases Waiting Period

The waiting period for pre-existing diseases is the duration that the policyholder must wait before raising any claims if, before applying for the health insurance, the policyholder has certain pre-existing diseases, such as diabetes or high blood pressure. Simply put, such exclusions in health insurance come with a waiting period. 

2.Initial Waiting Period

An initial waiting period is the duration that every policyholder must wait before filing any claim.

3.Named Ailment Waiting Period 

Every health insurance company has a list of named ailments or procedures, like cataracts or joint replacement, etc. To raise a claim for such procedures, the policyholder has to wait for a specific duration.

Disclosing Pre-Existing Conditions: Why is it Important?

At the time of applying for a health insurance plan, applicants with pre-existing conditions often find themselves tempted to hide this information from the health insurance company to avoid paying higher premiums or facing exclusions during the waiting period.

Remember that hiding such information can lead to the rejection of claims in the future or the revocation of the policy itself.

Health insurance companies ask applicants to disclose critical health information to ensure they develop the best available plan and coverage. Even if policyholders might find themselves paying a slightly higher premium or facing exclusions during the waiting period, in the long run, disclosing the right information can help them with quick claim settlement. 

How Does a PED Affect Health Insurance?

• If the policyholder is found to have a pre-existing disease, then certain changes might be made to the health insurance policy:
• The premium may be slightly higher to cover a pre-existing condition.
• Many health insurance companies don’t offer coverage for treatments of pre-existing diseases.
• Health insurance companies require every applicant to disclose such critical information.
• The policyholder must wait for the specified waiting period before they can raise any claims under the policy for pre-existing conditions. 
• Some health insurance companies don’t offer any coverage for high-risk pre-existing diseases like heart disease or cancer. 

Everything You Must Know While Buying Health Insurance for PED 

If you are purchasing a health insurance plan for a pre-existing disease, then there are a few considerations that you must bear in mind:

1.Get a Health Check-Up 

First, it is essential to undergo a health checkup to identify any pre-existing conditions.

2.Disclose Information

When purchasing your health insurance plan, be sure to disclose accurate information about your health conditions. Hiding such critical information can lead to rejection of your claim in future.

3.Understand the Waiting Period 

Health insurance companies typically have specified waiting periods for different pre-existing conditions that you must carefully evaluate and compare.

Did you know that the IRDAI has reduced the waiting period for pre-existing diseases from 4 years to 3 years?

4.Evaluate the Premium

Most health insurance companies charge a slightly higher premium if the policyholder has any pre-existing medical conditions. However, you can compare different policies and pick the one that offers coverage at an affordable premium.