Buying health insurance for your family feels like a safety net, until the term pre-existing disease (PED) shows up, leaving you with a dozen questions. Will my parents’ diabetes be covered? What about my spouse’s hypertension? Do we have to wait years before we can use the policy? The truth is, PEDs don’t have to be a roadblock if you understand how insurance companies handle them and plan your policy smartly.
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How to Handle Pre-existing Diseases (PED) in Family Health Insurance
A pre-existing disease under a family health insurance plan refers to any health condition, illness, or injury that a person, or policyholder, has been diagnosed with or treated for before purchasing a health insurance policy.
For example:
In India, the Insurance Regulatory and Development Authority of India (IRDAI) defines PED as any condition for which medical advice, diagnosis, or treatment was received within 48 months prior to buying the policy.
When it comes to buying family health insurance, many people are tempted to hide or downplay pre-existing conditions, fearing higher premiums or policy rejections. However, honest disclosure of pre-existing diseases (PEDs) is not just a formality, it’s a necessity.
Insurers rely on the information you provide to assess risk. If a PED is not disclosed, and a claim arises due to that condition, the insurer can legally reject the claim on grounds of misrepresentation. This could leave you paying out-of-pocket for expensive treatments.
Non-disclosure of PEDs is considered a breach of trust and can lead to policy cancellation, even after several years of paying premiums. When you’re honest about your health conditions, your insurer can customise the plan to suit your needs and ensure long-term protection.
By declaring PEDs, you allow the insurer to offer a plan that includes coverage for those specific conditions after the waiting period. It also helps you evaluate add-on riders or shorter waiting period options that are specifically made for families with existing illnesses.
Being honest about pre-existing conditions helps insurers set a fair premium and prevents surprises like sudden extra charges or any coverage gaps, especially when it comes to family floater plans as it is shared among all the members in the policy.
IRDAI rules make it compulsory to be honest about all existing health issues when buying insurance. If you skip this step, your claim is at risk of being rejected and you might even face legal complications, which can cause unnecessary stress during emergencies.
Most policies have a 2 to 4-year waiting period for PED-related treatments. And after completing the waiting period, PED coverage is available.
For individuals above a certain age, usually 45 years, or with known conditions, insurers may require medical tests before approving the policy.
In some cases, insurers may charge a loading fee, which is just an extra premium, to cover high-risk individuals.
Certain severe conditions, like HIV or cancer, during policy purchase might be permanently excluded.
Mahesh, a 42-year-old professional, bought a family floater plan of ₹3.5 lakhs for himself, his wife, and his parents. His father had diabetes for 8 years, but Mahesh didn’t disclose it, fearing higher premiums.
Two years later, his father was hospitalised due to diabetes complications. When Mahesh filed a claim, the insurance company discovered the undisclosed condition and rejected the ₹3.5 lakhs claim.
Had he disclosed the diabetes upfront, the policy would have either:
This shows us how non-disclosure can not only lead to your claim getting rejected but also defeat the purpose of buying health insurance.
Always provide complete and accurate health history during the proposal stage.
Some health insurers offer plans with a 1 or 2-year waiting period for PED coverage.
Certain policies provide riders to reduce waiting periods or extend additional PED coverage.
Buying a family health plan at a younger age reduces the chances of PED loading and long waiting periods.
If someone in your family has a serious health condition, it might make more sense to get them their own policy. Keeping them on a separate plan can give them more coverage, and save the rest of the family from higher premiums.
Take a few extra minutes to go through the policy details, especially sections about pre-existing conditions, what exactly is covered, and what’s not covered (like sub-limits). This can save you from unwanted surprises later.
Pre-existing diseases don’t have to be a barrier to good health insurance. With honest disclosure, the right plan, and a little patience during the waiting period, you can get reliable coverage for your entire family. Just make sure to read the fine print, ask questions, and choose what works best for your family’s unique needs.
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Reviewed by Dr. Harshita Dahiya 
Acko Technology & Services Private Limited
#36/5, Hustlehub One East, Somasandrapalya, 27th Main Rd, Sector 2, HSR Layout, Bengaluru, Karnataka 560102
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