Everything About Pre-Existing Diseases in Health Insurance Plan
Updated On Nov 17, 2020
While getting a new insurance plan, often a term called “Pre-existing disease” scares the buyer. Questions like will insurance are denied, what if I have asthma, or what if I have had a hospitalization long ago, come to mind. Let us try to understand this term a little more.
Read here: Pre-Existing Disease Cover from Day One by Popular Health Insurance Companies
What Are Pre-Existing Diseases in Health Insurance?
PED or the Pre-Existing diseases are the diseases which a policyholder has before the purchase of a health insurance plan. Pre-existing diseases condition or PED clause, as it is sometimes known as, is the condition set by the insurance company for allowing/rejecting any claims due to treatment/hospitalization related to many diseases that the insured is suffering from at the time of policy enrolment.
According to current IRDAI regulations in India, the maximum waiting time for covering Pre-existing diseases may not exceed 48 months if an insurance policy has been renewed without any discontinuity, and in a recent directive, the IRDAI has also asked for the removal of policy condition that allows an insurance company to reject a claim if a disease is reported within 3 months of enrolment considering it as PED.
Read more: Are Pre-existing Diseases Covered in Health Insurance Plan
List of Pre-Existing Diseases
There is as such no list of pre-existing diseases and many or any disease which was diagnosed before the beginning of the policy is considered to be a pre-existing disease. Even if you had met with an accident and developed a certain disorder, it would be classified as a pre-existing disease. Pre-existing diseases usually contain the following:
- Arthritis
- Asthma
- Diabetes
- Any stage of Cancer
- Glaucoma
- Hypertension
- Crohn’s Disease
- Gastrointestinal issues
- Cardiac issues
Things to Note about Pre-existing Diseases
- Not everything is considered as PED. It is always advisable to check with the insurance company regarding what is considered as PED by them. Hypertension, Diabetes, Asthma may come under this list, while hospitalization due to dengue may not.
- In case you have a condition that is considered a PED by the insurance company, there are policies that offer “Waiver of PED” as an option. Discussion with the company before purchase will let you know if you can avail such an option.
- The wait time for PED is different from other “Waiting Period” specifically mentioned in the Policy document. PED is mentioned separately. Usually, it is 24 to 48 months.
- Portability of policy, in India, currently allows the PED elapsed time to be considered in the new policy. So, if you port to a new policy after 2 years and the PED is 48 months in the new policy, as well, you would need to wait another 2 years instead of 4.
- Usually, Sum Insured changes, reset the Pre-existing clause. This is an important thing to note if you are starting with a lower sum insured and plan to increase it in future.
Know more: 4 Health Insurance Plans for Pre-existing Disease Coverage in India
Conclusion
If you are just getting started with health insurance, and are apprehensive about certain health conditions, consider evaluating health insurance plans carefully, comparing PED clauses and Waiver of PED options, if available. Usually, the long wait can be frustrating in some cases, so it’s best to choose wisely.
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.
