Pre-Existing Disease Cover in a Health Insurance Policy


5 min read

There are numerous advantages of buying a health insurance policy. It provides financial security in the event of medical emergencies, provides protection, offers an affordable alternative to costly medical expenses, and, lastly, it guarantees that you do not harm your health due to lack of funds. Similar to the numerous advantages of health insurance, it also comes with specific terms and conditions, and one of them is insurance coverage for pre-existing diseases.

Sanjay Kumar runs a hardware store and lives with his wife and kids. Though he is aged 45 years, he hasn’t taken any health insurance policy so far because of his pre-existing conditions, which might cost huge premiums. Sanjay is a diabetic and suffers from high blood pressure, because of which, the premiums quoted by most top health insurers were on the higher side. Although, he could still purchase health insurance plans for pre-existing conditions even if he has a medical history. Still, Sanjay feels the premiums shall climb upwards in the future owing to his state.

Pre Existing Disease Meaning?

It is a medical condition that exists with an individual when purchasing a health insurance policy. Medical conditions such as high blood pressure, diabetes, thyroid, asthma, depression, etc., are some of the ailments that feature in pre existing disease list. These can lead to chronic illnesses like heart diseases, asthma, and cancer, which pose a threat not only to our mental security but also to our financial health as the expenses to treat all these conditions are long-lasting. This includes the cost of medications, routine tests, diagnostics, and consultations, among others.

Also Read: List of Cheapest Health Insurance in India for 2022

What is a Pre-existing illness in health insurance Policy?

Earlier, it was difficult to obtain health insurance coverage for those suffering from pre-existing diseases (PED) but recently, the Insurance Regulatory and Development Authority of India (IRDAI) had revised the pre-existing illness list, thereby enabling policyholders to claim for such diseases as well after a specific waiting period.

So if you have any pre-existing disease and are looking for a pre existing disease health insurance plan, here are the essential things to keep in mind while selecting the right policy:

  1. Disclose any medical condition during registration: Many people believe that revealing pre existing conditions when purchasing an insurance policy will lower premium rates. But if it gets discovered that you have lied on the policy form intentionally, the insurer can end your insurance at any time. Concealing details or providing false information to your insurance company could only cause more problems for you. If you fail to disclose an existing illness, the insurance company reserves the right to deny your claim and possibly terminate your insurance. It is, therefore, the best option to be truthful and disclose all vital information about your health to insurance companies at the time of purchasing.
  2. Terms and Conditions of health insurance may differ: A vast majority of insurance companies will require you to go through an examination for medical conditions to determine whether you can be offered an insurance policy. Certain other insurers might also take into consideration your medical history and age. The screening procedure, wait time, and list of pre-existing conditions can vary based on the policy, company, and type of coverage offered. Therefore, it is necessary to examine the purchase process and the other terms of service before purchasing the policy.
  3. Waiting for time conditions for pre-existing illness: The purpose of waiting time is that you cannot immediately take advantage of the health insurance right after purchasing a policy. The policyholder has to wait for a timeframe that ranges from 3 months to up to 4 years. It is impossible to make insurance claims to receive any treatment during the initial waiting time. During this period, if you need medical attention, you will have to cover the cost from your pocket. The health policy will cover pre-existing illnesses once the waiting time is completed. This waiting time can differ between insurers and depend on the type of illness, policy type, age, coverage value, etc.,
  4. Check for pre-existing condition coverage: All health insurers don’t need to offer insurance coverage to cover pre-existing conditions. Specific health insurance plans don’t provide coverage for pre-existing conditions even after a brief waiting period. Hence, it is essential to check with your insurer and then select an appropriate plan at the time of purchase.
  5. Waiting time waiver: Certain insurance companies allow you to eliminate the waiting time required upon receiving a higher premium. In these cases, the waiting time decreases, or it is removed altogether. However, insurance companies may not provide this benefit in the event of a severe illness or you’re at a higher age. Therefore, it is advisable to verify this before deciding whether to purchase health insurance.
  6. Impact of pre-existing illnesses on premium: Pre-existing conditions can affect your health insurance policy premium. For example, if you suffer from a pre-existing disease, you will have to pay a premium that is higher than those who do not have those medical issues when purchasing the policy. The exact amount of compensation will be determined based on your medical condition, age, coverage value, medical history, etc.,
  7. Policy could be declined: The insurance company might deny you from buying their insurance plan for various reasons, including pre-existing disease. For instance, an insurance company could deny coverage against certain types of pre-existing ailments like diabetes, cancer, or even if you’ve suffered heart attacks in your past. In other cases, you could be eligible for health insurance, but certain other conditions might not be covered for the total duration of the plan.

Health insurance is among the most important financial instruments you should look into purchasing for your financial security. It’s affordable as well as flexible and efficient. It protects your savings but, the most crucial point to bear in mind is that you must not conceal or lie about your medical history. It might look like saving some money by hiding but you might have to incur a high cost in the future when your claim is denied. Hence, buying a pre existing disease cover health insurance might be a wise decision in case you have a pre-existing health condition.

Also Read: What is a Third Party Administrator (TPA) in Health Insurance & its Role?

FAQs on Pre-Existing Disease in a Health Insurance Policy

Can I get medical insurance with pre-existing condition?

A medical insurance plan will cover pre-existing illnesses after the waiting period is over. The waiting period can vary from insurer to insurer and also depend on the type of illness, policy, age, and other similar factors. It can typically be between two years to four years.

What is pre-existing disease waiting period in health insurance?

What is pre-existing disease waiting period in health insurance?
Almost all health insurance plans cover pre-existing diseases after a waiting period of usually 2 to 4 years. This implies that any hospitalization expenses related to the declared ailments can be claimed only after 4 successful years with the insurer.

What is considered as pre-existing disease?

A medical illness or injury that you have before you start a new health care plan may be considered a pre-existing condition. Conditions like diabetes, chronic obstructive pulmonary disease (COPD), cancer, and sleep apnea, may be examples of pre-existing health conditions.

What are some examples of pre-existing conditions?

A pre-existing condition is a health problem you had before the date that your new health coverage starts.
Epilepsy, cancer, diabetes, lupus, sleep apnea, and pregnancy are all examples of pre-existing conditions.

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Feb 02, 2022
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PayBima is an Indian insurance aggregator on a mission to make insurance simple for people. PayBima is the Digital arm of the already established and trusted Mahindra Insurance Brokers Ltd., a reputed name in the insurance broking industry with 17 years of experience. PayBima promises you the easy-to-access online platform to buy insurance policies, and also extend their unrelented assistance with all your policy related queries and services.

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