Get All Your Queries Related to Health Insurance Answered Here!

Health Insurance Blog

How Pre-Existing Diseases (PED) Affects Your Health Insurance

Health Insurance Guidelines

The need for health insurance is acknowledged by everyone looking at the soaring prices or inflation in the healthcare industry. However, your pre-existing diseases or PEDs might cause an issue in obtaining the best policy you are seeking at the best rate. In this post let us take a look at the PED in health insurance and their role in making a health insurance premium either cheap or expensive.  So, what is a pre-existing disease? 

What is a Pre-Existing Disease/Condition?

Any medical condition that you suffer from at the time of buying a health insurance policy is called health insurance pre-existing condition. These conditions can be anything ranging from a severe illness such as diabetes, Alzheimer’s, cancer etc., or less severe conditions like asthma, hypertension etc. 

In most cases, health insurance companies are not willing to offer insurance coverage to individuals who are suffering from pre-existing health conditions. This is because these individuals act as liabilities to the insurance company as they pose greater risk of health instability with the pre-existing diseases they suffer.  Hence, people with pre-existing diseases find it difficult to avail adequate coverage on their health insurance. 

In some extreme cases, insurance companies might cancel such policies or may refuse to settle the claims raised by individuals suffering from pre-existing conditions. It is, therefore, very important to know some important aspects related to pre-existing diseases. One such important aspect is Pre-existing disease waiting period.

What is the Pre-Existing Disease Waiting Period?

A pre-existing disease waiting period is a time period (of two to four years depending on the insurer) during which insurance companies do not settle claims on PEDs or pre-existing diseases. Generally, most insurers cover pre-existing diseases only after completing the required waitin9g period.

Is it important to note that the pre-existing disease waiting period can be different for different insurance companies. It is entirely up to the discretion of the insurance company to see how many years of waiting period they want to apply on a particular health plan.

Switching insurers during this period is not recommended as the current waiting period served under one insurance company may not be considered by the new insurer. Nevertheless, now-a-days companies are coming with plans which allow policyholders to reduce the PED waiting period by means of paying an extra premium through a rider.

Let us now discuss the important things that are important to consider while buying health plans with PEDs.

health insurance plan

Get ₹5 lac health insurance

starting @ ₹245/month*
*Terms & conditions apply

Things you should know

As per the above information, below are some points that you must note while planning to buy a health insurance policy to consider pre-existing conditions in medical billing.

Every insurance policy is different

It is important to note that policies generally differ from one another depending on the insurance company. The terms and conditions of every policy is unique, especially in terms of pre-existing disease coverage. It is not easy to obtain a policy that will offer encompassing coverage for PEDs. However, there are always exceptions that you may seek for. Some insurance companies consider the entire medical history of the applicant while considering the PEDs at the time of offering policy. On the other hand, some insurance companies may consider only the last 4-5 years of medical history while offering the insurance plan.

Doctor Visit for Minor Illnesses are not Counted

Making frequent visits to the doctor for consulting minor issues like seasonal cough and cold, fever etc., are not causes of worry for applicants who are planning to buy insurance. You must note that not all trips made to the doctor are counted as serious while applying for health plans. Insurers generally consider health conditions that have a long-term effect on the health of a person. Hence, minor ailments do not regulate the health insurance pre-existing disease criteria.

Don’t Conceal Information about Pre-Existing Medical Conditions

Many people tend to hide information from the insurance companies about the pre-existing conditions that they are suffering from thinking that the insurer will never come to know about them. But the fact is, it is really considered unwise to hide information on PEDs from the insurer at the time of buying an insurance policy. This is because, if you raise a claim for such a condition later the insurer may reject your claim.

health insurance

Get ₹10 lac health insurance

starting @ ₹334/month*
*!Terms & conditions apply

Coverage for Pre-Existing Medical Conditions is Available

There is an impression among people that insurance companies do not allow PED cover. But the fact is, health insurance companies do offer coverage against health insurance pre-existing conditions after completing the waiting period. A PED waiting period is the time duration of two to four years depending on the insurer that is imposed by them on policies sold to people who have a pre-existing health condition. So, during this duration of the waiting period, the insurer will not cover the costs of hospitalization and other treatment related to the PED condition. Only when the duration of PED is completed, the costs of treatment for such diseases are covered. However, in the meantime you continue to receive coverage for treatment of other diseases covered as part of the insurance policy.

Reduction of Waiting Periods is Possible

Though the duration of PED waiting period depends on the particular health insurance policy and it differs from insurer to insurer. It is mostly between 2 years to 4 years depending on the insurance company. During this time, it is recommended not to switch insurers because the new insurance company that you move to may or may not consider the waiting period that you have already completed with the earlier insurer. In that case, you will have to go through the waiting period once again. However, some insurance companies have come up with policies that allow the insured individuals to reduce the duration of waiting period by availing an add-on rider of waiting period reduction by paying an extra premium.

health insurance

Get ₹20 lac health insurance starting

@ ₹600/month*
*$Terms & conditions apply

To Conclude

Whether you suffer from a pre-existing condition or not, you can anyway obtain health insurance coverage. All you need is to check the waiting period for PEDs as well as pre-existing disease list under your policy and accordingly decide if you want to reduce it or carry on with the plan.

* Rs. 245/month is the starting price for a 5 lac health insurance for an 25-year-old male, with no pre-existing diseases.
*! Rs. 334/month is the starting price for a 10 lac health insurance for an 25-year-old male, with no pre-existing diseases.
*@ Rs. 12/day is the starting price for a 5 lac family health insurance for an 25-year-old male and 22-year-old female, with no pre-existing diseases.
*# Rs. 12/day is the starting price for a 5 lac health insurance for an 25-year-old male, with no pre-existing diseases.
*$ Rs. 600/month is the starting price for a 20 lac health insurance for an 25-year-old male, with no pre-existing diseases.
*^ Rs. 12/day is the starting price for a health insurance that covers coronavirus for an 25-year-old male, with no pre-existing diseases.