Health Insurance with Pre-Existing Condition
Published On Mar 17, 2019, Updated On Apr 12, 2021
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 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
What is a Pre-Existing Condition?
As a layman, you might interpret it as an illness or ailment that a person has at the time of 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, the higher level of sugar, etc.
- Medication for any illness or disease like taking diabetes or hypertension pills, etc.
- Any history of skin disorder such as vitiligo, psoriasis, etc.
- Any history of major accident/injury 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 illness 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 health 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 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 cataract, 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 on the basis of 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 Health Insurance Plan
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 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, which 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 the 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. Waiting period waive off: It is always advisable to port the policy after the completion of the waiting period. Though, nowadays, most of the insurers give waive-off benefit 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 ailment.
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|
|Max 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
Bajaj Allianz Silver Health
Star Senior Citizen Red Carpet
Why is it necessary to Reveal Pre-Existing Illness?
At the time 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 case, the policyholder hides any pre-existing illness from their respective insurance company in order to avoid paying high premium or any other reasons, and they come to know about it later, then the insurer during the emergency can reject the claim on the grounds of cheating and non-disclosure of pre-existing illness.
So, to conclude if you or any of your family members is 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 which insurance companies define as “pre-existing condition.” All these things will help you not only buy the aptest plan for yourself or your family members but will 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 health care needs. It is just a matter of searching and finding a policy that provides health covers to 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 email@example.com for all your health care needs and have the best of health, now and forever!