Health Insurance with Pre-Existing Condition- Terms & Tips
Updated On Jan 22, 2024
Are you the one who suffers from a pre-existing condition and is losing faith in health insurance due to random claim rejections? Are you confused about the term “pre-existing conditions?” Are you concerned about buying a policy for yourself or your parents due to a pre-existing disease? All of these questions and many more are answered right here!
Let’s start with what is meant by a pre-existing condition
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What is a Pre-Existing Condition For Health Insurance?
As a layman, you might interpret it as an illness or ailment that a person has when buying a policy. But, more than that, it also includes:
- Any medical history of illness such as a history of heart attack, stroke, diabetes, etc.
- Any history of hospitalisation such as hospitalisation for kidney stone removal, breast surgery, etc.
- Any signs or symptoms of illness such as increased sweat, obesity, a higher level of sugar, etc.
- Medication for any illness or disease like taking diabetes or hypertension pills, etc.
- Any history of skin disorders such as vitiligo, psoriasis, etc.
- Any history of major accidents/injuries such as head injury, prosthetic limb, etc.
- Any illness that you have or had before or at the time of policy purchase such as diabetes, high blood pressure (hypertension), etc.
A long list, of course! Health insurance companies are generally reluctant to cover individuals with pre-existing illnesses due to higher chances of recurrent claims in the future. But, you can still buy the policy by adhering to certain terms and conditions put by the health insurance companies.
Terms and Conditions for Health Insurance with Pre-existing Diseases
Here’s a list of some of the terms and conditions listed for medical insurance with a pre-existing condition:
1. Premium loading
In case you have a pre-existing ailment, your premium would be higher than any other person of the same age but without any illness. Note, as per the Insurance Regulatory and Development Authority (IRDA), insurance companies are not allowed to load their customer for any illness that occurs after a policy issue or renewal without any break.
2. Waiting period
There is a pre-defined waiting period ranging from 2 years to 4 years varying from one insurer to another. After the waiting period is over, pre-existing ailments are covered depending on the plan. For example, typically for cataracts, the insured is covered only after an initial waiting period of 2 to 4 years.
3. Waiting period plus premium loading
In some instances, you may have both the waiting period and the premium loading.
4. Medical check-up
If you have a pre-existing disease, there might be a possibility that based on your medical check-up result, the insurance company would decide whether to issue you a policy or not.
5. Permanent exclusion
Sometimes considering the severity of the pre-existing condition, the insurance company might offer you coverage only if you agree on a permanent exclusion for your pre-existing disease.
6. Policy Denial
There are even chances of policy denial in case your pre-existing illness is chronic and severe like diabetes, history of heart attack, cancer, etc.
Things to Consider Before Purchasing a Health Insurance Policy
Does that mean if you or any of your near and dear ones have a pre-existing disease, buying a health insurance policy would be difficult? No, this is not the case. You can still buy Health/Medical insurance just by keeping yourself informed and searching extensively during the purchase of a health plan.
So how do you work around this? Here is some information that could help as you shop for health insurance:
1. Different insurers have different policies
It is difficult to get health insurance due to a pre-existing condition, but not always. There are some insurance companies, that consider an individual’s health condition throughout the years, and there are others who only look at the last few years (preferably the last four years) medical records. The terms and conditions of the coverage differ from plan to plan.
2. Frequent trips to doctors are not necessarily counted
The insurance companies are concerned about pre-existing health conditions that have a long-term effect. If you have frequent visits to doctors due to cough, cold, or fever these are not considered by the insurers, as they do not pose any long-term effect on a person’s health.
3. Pre-existing health conditions should be disclosed
Non-disclosure of a pre-existing condition may result in a rejection of a claim. It is always wise to disclose your health condition to the insurer at the time of policy purchase.
4. Coverage for pre-existing illnesses
In most cases, pre-existing diseases are covered after a waiting period unless there is an exclusion for such a condition.
5. The waiting period waived off
It is always advisable to port the policy after the completion of the waiting period. However, nowadays, most insurers give waive-off benefits for the waiting period. It means that if there is a waiting period of four years and the policyholder has completed two years then he can switch to a new insurer and has to bear only the remaining two years of waiting period with the new plan.
Some policyholders also allow a reduction of the waiting period by payment of an extra premium. However, it varies from insurer to insurer. You need to check the terms and conditions of the plan for a waiting period clause under the pre-existing condition. During the waiting period, the insurer doesn’t provide coverage for doctor’s visits, medicines, and treatments for pre-existing ailments.
So, now you understand even if you have a pre-existing condition, still, no insurance company can reject you. Due to the competition, the market is flooded with plans. The insurers are ready to take the risk when it comes to offering health policies to individuals with pre-existing health conditions.
Health Insurance Plans with Pre-Existing Diseases
Here’s a list of some of the plans that you can navigate through if you or any of your loved ones are suffering from a pre-existing ailment:
| Insurance Company | Plan Name | Waiting Period |
| Star Health Insurance Company | Senior Citizens Red Carpet Plan | 1 year |
| Bajaj Allianz General Insurance | Silver Health Plan | 1 year |
| Oriental Insurance Company | HOPE Senior Citizen Health Insurance | 2 years |
| Bajaj Allianz General Insurance | Health Care Supreme | 2 years |
| Max Bupa Health Insurance | HeartBeat Plan(Platinum) | 2 years |
| Max Bupa Health Insurance | HeartBeat Plan(Gold) | 2 years |
| HDFC Ergo General Insurance | Optima Senior Plan | 3 years |
| Bajaj Allianz General Insurance | Health-Guard (Silver Plan) | 3 years |
| Star Health Insurance Company | Medi Classic Insurance Policy (Individual) | 4 years |
| Star Health Insurance Company | Family Health Optima | 4 years |
| Royal Sundaram General Insurance Company | HealthShield Standard Insurance Policy | 4 years |
| TATA AIG General Insurance Company Limited | MediRaksha Insurance Plan | 4 years |
| Niva Bupa Health Insurance | Heartbeat Plan | 4 years |
Plans with 4 years of a waiting period
- Star Health – Medi Classic (Individual)
- Star Health - Family Health Optima
- Royal Sundaram – HealthShield Standard
- TATA AIG MediRaksha
- Max Bupa HeartBeat - Silver
Plans with 3 years of a waiting period
- Bajaj Allianz – Health Guard - Silver Plan
- Apollo Munich – OptimaSENIOR
- Universal Sompo Health Insurance Plans
Plans with 2 years of a waiting period
- Max Bupa HeartBeat - Gold
- Max Bupa HeartBeat - Platinum
- Bajaj Allianz Health Care Supreme
- Oriental Senior Citizen HOPE
Plans with 1 year of a waiting period
Why is it necessary to Reveal Pre-Existing Illness?
At the time of buying a health insurance plan, the policyholder signs the proposal stating everything mentioned in the plan is correct. Therefore, it is important to be as transparent as possible. In this case, the policyholder hides any pre-existing illness from their respective insurance company to avoid paying high premiums or any other reasons, and they come to know about it later. The insurer during the emergency can reject the claim on the grounds of cheating and non-disclosure of pre-existing illness.
Conclusion
So, to conclude if you or any of your family members are suffering from a pre-existing medical condition don’t despair. While buying the policy keep the insurer informed of your health condition and any pre-existing ailments that you suffer from. Get all the necessary checks and tests done before purchasing the policy. Any diseases like blood pressure, sugar, kidney-related conditions, etc., which may pose the risk of rejection at the time of claim should be disclosed right away.
Read the policy wording to understand the type of diseases that insurance companies define as “pre-existing conditions.” All these things will help you not only buy the aptest plan for yourself or your family members but also help you have a quick settlement process for all your future claims.
With cut-throat competition in the health insurance sector, there is an answer to all your healthcare needs. It is just a matter of searching and finding a policy that provides health coverage for such conditions. We at insurancedekho.com will help you navigate through a variety of options available in the health insurance market and buy the best plan worry-free. Just write to us at customersupport@insurancedekho.com for all your healthcare needs and have the best of health, now and forever!
