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Home / Health Insurance / Pre-existing diseases and conditions in health insurance
People often underestimate the importance of purchasing a comprehensive health insurance policy. They rely on savings and employer-offered insurance. However, that might not be a wise plan in today’s times when medical expenses are on the rise. Therefore, it is suggested to cover you and your loved ones with a suitable health insurance plan. But do health insurance policies cover pre-existing conditions – ones that you are already suffering? Not exactly. That is why it is suggested to buy a health insurance plan early on in life. This not only ensures you are charged a low premium but also gets you better coverage as the chances of acquiring diseases are low at a young age as compared to an ageing body. If you already have a disease and still want health insurance, this article will tell you all you need to know to do so. Read ahead to know details about health insurance and pre-existing conditions.
Pre-existing conditions are those conditions that you already suffer from while (and in some cases before) buying an insurance policy. As the name suggests, they exist before you pay the insurance premium. If you have faced a major accident, such instances can also fall under a pre-existing condition based on the severity.
Insurance is a concept where the insurance company offers financial assistance in case something unfortunate happens to the insured asset as per the terms and conditions. In this case, since the insurance companies know that a person already has a pre-existing condition, the probability of claims rises. Therefore, health insurance companies are a bit reluctant about covering pre-existing diseases. Some might cover them as per terms and conditions and charge a higher premium for it.
Also, check: Arogya Sanjeevani Health Policy
Here’s a list of repercussions a pre-existing disease might have on your health insurance policy. Different insurance companies might have different clauses. Thus, it is suggested to go through the respective Policy Wordings carefully before buying a health insurance plan.
This means the premium charged will be on the higher side. The premium will be loaded because the insurance company is taking the risk of covering a pre-existing disease. Such premium loading is only applicable at the time of purchasing the policy. It cannot be charged again if the policy is renewed on a continuous basis without any break in between.
This is the period for which you have to wait before the pre-existing illness is covered by the insurance policy. There is no standard waiting period. It depends upon the illness, the cover, and the insurance company offering the policy. For example, if a hernia is declared as pre-existing disease, the waiting period for it will be around four years. This means the policy will cover hernia after four years from policy purchase date considering there is continuous coverage.
Learn more about waiting period in health insurance
There might be situations where you will be charged a higher premium as well as have a long waiting period to cover an illness. Such a situation arises because of a severe condition like high hypertension.
In case you have a pre-existing disease, the insurance company might ask you to go for a medical check-up. The insurance premium will be based on the test results. There is a chance that the insurance company might refuse to offer a policy if the results are unfavourable.
Also, read: Pre-Policy Medical Check-Up and Tests
The insurance company might offer you insurance coverage but exclude the pre-existing disease. Here, you will have to agree that the said pre-existing disease is a permanent exclusion in the policy. This way, you might be uninsured against a disease or diseases but shall be covered for other health scenarios based on the terms and conditions of the policy.
The insurance company can refuse to offer you insurance coverage based on pre-existing condition. In such cases, they will deny your application to purchase a health insurance policy.
Buying health insurance for senior citizens with pre-existing diseases can be slightly tricky. That is why it is suggested to buy health insurance early on in life.
Here’s the process to buy health insurance for the elderly.
Step 1: You can buy health insurance for parents with a pre-existing illness the usual way, via online or offline.
Step 2: Most likely, the insurance company will ask for medical tests.
Step 3: Once the tests are done, the company’s underwriting team will analyse the results and let you know the status.
Step 4: The company might ask for more premium or deny the policy.
Do Share Information About Pre-existing Diseases With Insurer:
Be transparent while communicating with the insurance company. The insurer might ask some questions related to your health conditions, be truthful.
It is a good idea to get a health check-up done voluntarily. It will let you know if you have any existing diseases and help you act on them in a timely manner.
Also, read: Preventive Health Check-up
Be transparent with the insurer. Do not hide any information pertaining to your medical history.
If one insurance company refuses to offer you a policy or charges you a lot to cover a pre-existing disease, you can research online and look out for other options as well.
Here are some important points you must be aware of related to pre-existing diseases and health insurance.
Different Insurers Have Different Policies:
All companies do not follow the same rules when it comes to pre-existing disease insurance. There is no best medical insurance for pre-existing conditions. Some insurers might cover a pre-existing disease, some might not. Some might have a reduced waiting period while some might have an extended waiting period. Therefore, read the terms and conditions carefully before purchasing the plan.
Every Doctor Visit Is Not Counted:
You do not have to worry about disclosing illnesses like common cough or cold. Visiting a doctor to treat your headache isn’t a problem. However, if you have been having the headache continuously for a year and you are on medication, then it can be considered as a pre-existing disease.
Hiding A Pre-existing Disease:
It is best to be honest and transparent with the insurance company regarding pre-existing conditions to avoid hassles during claim settlement.
Pre-existing Disease Can Be Covered:
Some pre-existing diseases might be covered with the waiting period clause. Therefore, there is no directive on not covering pre-existing diseases.
Waiting Period Can Be Reduced:
Different insurance providers might offer similar coverage with a reduced waiting period. They might do it for a higher premium.
Different insurance companies offer policies with different pre-existing diseases. The pre-existing diseases list will be clearly mentioned in the Policy Wordings.
Yes, some mental disorders are a part of pre-existing diseases.
You can apply for a health insurance plan if you have a pre-existing disease. The company will follow its due process and let you know if you can buy health insurance with pre-existing disease cover.
Health insurance companies might reduce the waiting period by charging a higher premium. Such decisions are based on individual company policies.
Yes, a health insurance company can refuse to offer a health insurance policy based on a pre-existing disease as per their terms and conditions.
*Except for exclusions like maternity benefits, undisclosed diseases, etc. Please check policy wordings for more details.
The content on this page is generic and shared only for informational and explanatory purposes. It is based on industry experience and several secondary sources on the internet; and is subject to changes. Please go through the applicable policy wordings for updated ACKO-centric content and before making any insurance-related decisions.