Health insurance policies in India have become popular due to the financial security that it provides during medical emergencies. However, we often tend to miss one important factor. It is the coverage of pre-existing diseases in health insurance policies. Given the changing lifestyle and habits, diseases like asthma, blood pressure, cholesterol, and diabetes have become very common. Hence, it is important to have pre-existing disease coverage in your health insurance policy.
Most regular health insurance policies do not cover these pre-existing diseases. This is because it increases the chances of claiming the policy for the treatment of such health conditions. However, health insurance companies have also evolved with time to cater to every individual’s health needs. Many health insurance policies now provide coverage even if the applicant has a pre-existing disease.
Read in detail about pre-existing disease cover in health insurance and the conditions applied to it.
Pre Existing Disease Health Insurance : Overview
The Insurance Regulatory and Development Authority of India (IRDAI) defines pre-existing diseases (PED) as injuries, sickness, or any medical conditions diagnosed before buying a health insurance policy. Severe cases of injury are also considered PED in some policies. This definition excludes any diagnosis of illness within the first three months of purchasing a policy.
What is pre-existing disease in health insurance?
In health insurance, a pre-existing disease refers to any condition that a policyholder has been diagnosed with before purchasing the insurance. Generally, pre-existing diseases are covered after a waiting period specified by the health insurer. The waiting period may vary from six months to four years depending on the health insurance company. Pre-existing conditions are usually not covered in the initial waiting period; however, coverage starts once the waiting period is over.
The healthcare costs of a pre-existing disease are typically higher, which is why some health insurers have exclusions or higher premiums for pre-existing conditions. Therefore, it is important to disclose all pre-existing conditions when purchasing health insurance to avoid any future claim rejections or complications.
What is a pre-existing illness?
Pre-existing diseases refer to medical conditions that intending policyholders are already suffering from while purchasing an insurance policy.
According to IRDAI, any disease or condition diagnosed up to 48 hours before purchasing the policy is a pre-existing illness. Pre-existing illnesses include long-term health issues, some of which are:
- High blood pressure
- Asthma
- Thyroid
- Diabetes
- COPD
Important things to know about health insurance for pre-existing medical conditions
Here are a few things that you must be aware of about buying a health insurance policy that covers pre-existing diseases:
● Disclose any pre-existing medical condition
It is mandatory to disclose any pre-existing diseases that you may have at the time of buying a health insurance policy. In case of non-disclosure, the insurance company can rightfully reject your claim. Providing false or misleading information or hiding health details from the insurer will complicate matters at the time of raising claim requests. Eventually, burdening you financially at the time of a medical emergency.
● Insurance terms and conditions may differ for pre-existing illnesses
Most insurance companies ask for medical check-ups to screen pre-existing health issues before offering a health insurance policy. Some insurers may also consider the applicant’s age and medical history before providing pre-existing disease coverage. The screening process, the list of pre-existing conditions, and the waiting period will differ for different insurance companies and health plans. Therefore, it is advisable to check the terms and conditions before opting for a health insurance policy.
● Pre-existing illness can affect insurance premiums
It is important to keep in mind that insurers charge higher premiums to people with pre-existing illnesses. The insurance company will determine the exact premium amount based on an applicant's age, illness, etc. However, applicants must be transparent about disease history regardless of the premium charges.
● Not all health plans cover pre-existing diseases
There may be some health plans that do not cover applicants against pre-existing ailments. Insurers may also not cover some pre-existing diseases for the entire policy tenure. Therefore, you must check with the insurance company about this and select a policy accordingly.
