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All You Need To Know About Pre-existing Disease in Health Insurance

Published On Mar 03, 2021, Updated On May 01, 2021

Health insurance is the best way via which one can avail enjoy cashless hospitalization and treatment without breaking their bank. But procuring health insurance is not common for all people. For instance, people with pre-existing diseases are imposed a waiting period to cover their existing illness under the policy or are made to pay a higher premium.

What are Pre-Existing Diseases?

Pre-existing diseases refer to any health problem, illness, or injury that the person seeking insurance has been suffering from, at least 48 months before the date of purchase of the policy. Some of the pre-existing diseases that are classified by the insurance company are diabetes, COPD, Cancers, hypertension, thyroid, asthma, and sleep apnea.;

According to the recent guideline by the Insurance regulatory and development authority of India, (IRDAI) no disease should be categorized as a pre-existing disease if it is diagnosed three months after buying the policy. IRDAI also states that, if the insured is diagnosed with a terminal illness after buying the policy, then the insurer should not impose any waiting period or higher premiums on the policy.

Health Insurance With Pre-existing Medical Conditions

Earlier it was difficult for people with pre-existing diseases to seek health insurance. The instances of claims rejection and increase in the waiting period were also much pronounced. But with the latest guidelines by the IRDAI, it has become easy for people to seek health insurance though it comes with a waiting period. Some things to remember while seeking health insurance with a pre-existing disease are as follows.

1. Disclose Complete Information Regarding Pre-Existing Diseases

People should first understand what pre-existing diseases are. Minor cold, cough, and fever are not pre-existing diseases and not every single ailment is a pre-existing disease. The list of pre-existing diseases that are included for claims under the health insurance coverage will be given by the insurance company.

Policy seekers should never hide any medical condition, that can affect their chances of getting a policy. Some people hide their pre-existing disease fearing higher premiums. But if the health insurance company learns about this disease later, it will either reject the claim or even revoke the entire insurance policy.

2. Medical Check-ups

Some health insurance providers will expect the policy seekers to undergo a complete medical checkup before issuing the policy to them. This is to identify the existing disease in advance and modify the policy accordingly.

3. Waiting period

All health insurance plans for people with pre-existing disease have a waiting period. This could last from 24 to 48 months before the disease is included for claims. It will be beneficial to search for a health insurance plan with a low waiting period so that the pre-existing disease gets covered at the earliest. There are also ways to reduce this waiting period for pre-existing diseases as an add-on benefit, by paying an additional premium.

4. Premiums

The premiums of health insurance policies with pre-existing diseases will be on the higher side, as the insurance company is taking the risk of insuring a person with a pre-existing illness.

Bottom Line

The health insurance policy is a safety cushion that keeps the person safe from increasing medical costs. Earlier it was tough for people with pre-existing diseases to seek medical insurance. But now the IRDAI has made it easy for anybody to enjoy a comprehensive health cover.

Disclaimer: This article is issued in the general public interest and meant for general information purposes only. Readers are advised not to rely on the contents of the article as conclusive in nature and should research further or consult an expert in this regard.

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