There are many technical terms you will come across while buying Family Health Insurance. Two such common terms are Pre-existing and Lifestyle Diseases. These are medical conditions that you need to be aware of while selecting the coverage. You might have questions like is my parent's diabetes covered? Is my daughter's asthma covered? How much do I need to wait before making a claim? The truth is, PEDs and lifestyle diseases don’t have to be a roadblock if you understand how insurance companies handle them. Let’s deep dive into these coverages to clear the confusion.
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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.
Lifestyle diseases are health conditions that develop due to unhealthy habits and routines over time. They are not caused by infections but by factors such as poor nutrition, physical inactivity, stress, smoking, and excessive alcohol use.
Common lifestyle diseases include:
No, pre-existing diseases and lifestyle diseases are not the same. However, the type of disease can overlap. This is because an insurer will consider any disease as pre-existing if the insured member is suffering from it since before buying a family health insurance plan. On the other hand, lifestyle diseases develop over time due to unhealthy habits or lifestyle choices.
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.
Smooth claim process
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.
Lifestyle diseases are no longer limited to older adults. Even younger people are being diagnosed earlier, often due to sedentary lifestyles, poor food habits, and long work hours. Children are also at risk due to lack of physical activity and unhealthy diets.
For families, this means:
Most policies have a 2 to 3-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 health plan of ₹10 lakhs for himself, his wife, and his parents. His father had Type 2 diabetes for 8 years, and Mahesh disclosed it while buying a Family Health Insurance Plan.Three years later, his father was hospitalised due to diabetes complications. When Mahesh filed a claim, the insurance company paid a ₹1.5 lakhs claim.
Take away:
Since Mahesh disclosed his father’s pre-existing disease, he received coverage after the waiting period. He could thus easily afford expensive treatment with his Family Health Insurance plan.
| Advantages of PEDs and Lifestyle Disease Coverage | Disadvantages of PEDs and Lifestyle Disease Coverage |
| Cost-effective for families with multiple members needing care | Waiting periods may delay access to benefits |
| Covers treatment and prevention together | Outpatient benefits may be limited or optional |
| Reduces stress from ongoing medical bills | Lifestyle counselling or wellness may not be included in basic plans |
| Encourages early detection and regular check-ups | May have sub-limits on room rent or medicines |
Lifestyle disease coverage is useful for these people.
While coverage is broad, there are still some limits. Most policies do not cover the following.
Pre-existing and lifestyle diseases don’t have to be a barrier to good health insurance.
Pro tip: 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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