Pre-existing Diseases Covered in Health Insurance

According to the Insurance Regulatory and Development Authority of India (IRDAI), pre-existing illness is classified as medical conditions that have been diagnosed before purchasing a health insurance plan.

It simply means that the insurer knows about the medical condition. Generally, the insurance company, in that case, asks insurers to serve a waiting period before availing the health insurance benefits.

Moreover, health insurance that covers pre-existing conditions in India has a different waiting period compared to the base cover in medical insurance. Also, the waiting period may vary from insurance company to company – Generally, it ranges between 2 - 4 years.

Below is the list of some pre-existing diseases covered under the health insurance plans.

The general health insurance policies offered by the insurance company offer financial assistance to individuals in case of a medical emergency. The chances of raising a claim for a health insurance policy are 50-50 in that case.

However, with a pre-existing disease, the insurance company and insurer both know that they will definitely raise a claim due to medical conditions. The health insurance plan for pre-existing illness clauses can vary from insurance company to company.

Below are some of the effects that pre-existing illnesses have on medical insurance policies.

High Premium - Due to the pre-existing disease, the health insurance premium for a policy will be high. This is because the insurance company is taking a risk of covering the existing illness treatment. Also, based on the type of pre-existing disease a person has, insurance companies can decide the premium.

Waiting period - Another impact a pre-existing disease has on a medical insurance policy is to ask policyholders to serve a decided waiting period. The waiting period is different in that case; it can vary depending on the insurance company.

Below are some of the points to remember while purchasing health insurance policies covering pre-existing diseases in India.

1. The terms and conditions for health insurance for pre-existing conditions can differ

The screening process, waiting period, list of pre-existing illnesses, etc., can differ based on the health insurance policy, type of coverage, riders, insurance company, etc. Most insurance providers would request you to undergo a medical check-up, based on which you will be offered a policy. Some insurers may also consider your health history and age. Therefore, you must check the process of purchase and the terms and conditions before you select a medical insurance plan.

2. You should always disclose your pre-existing illness

Hiding details or providing misleading information to the insurance provider would only complicate things for you. In case of non-disclosure of a pre-existing condition, the insurance company reserves the right to reject your claim and also cancel your policy. This can be harrowing in times of urgency. Therefore, it is in your best interest to always be honest and share all crucial details of your health with the insurer at the time of purchase.

3. Pre-existing illnesses should be disclosed before you purchase a health insurance policy

A lot of people think that disclosing a pre-existing illness after they have purchased a medical insurance plan will fetch them a lower premium and help them save more money. However, if you are found guilty of lying on your policy document purposely, the insurance provider can cancel your policy anytime.

4. Not all health plans cover pre-existing conditions

Not all health insurance plans cover pre-existing conditions. Some plans may not offer you any protection against such ailments. Therefore, you must confirm with the insurance company at the time of purchase and select a plan accordingly.

5. There is a waiting period for pre-existing conditions

The basic understanding of the waiting period is that you cannot claim health insurance immediately after buying a healthcare policy. The policyholder must wait for a set time frame that ranges from 30 days to 4 years. The waiting period is the duration of time during which the insurance company will not compensate you for a claim related to your pre-existing ailment.

In such a case, you would have to bear the expenses out of your pocket. The first 30 days after buying a healthcare plan is the initial waiting period, constant for all types of health insurance policies. You cannot avail of an insurance claim for any treatment in this initial waiting period. A medical insurance plan will cover pre-existing illnesses after the waiting period is over.

The waiting period can vary from insurer to insurer and also depend on the type of illness, policy, age, and other similar factors. It can typically be between two years to four years.

6. You can waive the waiting period in some cases

Some insurance companies offer the option to remove the waiting period clause on the receipt of some extra premium. Under this option, the duration of the waiting period is either reduced or the waiting period is entirely removed.

However, the insurance company will waive the premium based on the severity of your illness. The insurance company may also not offer you this option if your condition is severe or you are at a relatively advanced age. So, confirm this before you go ahead and purchase health insurance.

7. The pre-existing illness can affect the premium of your health insurance policy

A pre-existing condition can impact the premium of your medical insurance plan. If you have a pre-existing illness, you would have to pay a higher premium compared to applicants with no medical conditions. The precise premium amount would be decided on the basis of your illness, age, policy coverage, etc.

However, an important thing to keep in mind is that no matter the cost of the premium, you should never lie about your health history. You may save more by hiding information in the present but can incur highly high costs at a later stage if your claim is rejected and you are forced to pay for your medical bills out of your pocket.

8. The insurance provider can deny you a health insurance policy

The insurance company can deny you coverage against certain types of pre-existing illnesses, such as cancer, diabetes, or if you have suffered heart attacks in the past. In some cases, you may get a health insurance plan, but certain illnesses may be excluded for the entire length of the policy.

Health insurance is one of the most essential financial tools that you can consider purchasing for a financially secure future. It is affordable, flexible, and practical. It safeguards your savings and lets you live stress-free by protecting you and your loved ones. However, the credibility of your insurance plan largely depends on its coverage and features. So, it is best to compare health insurance plans before purchase.

Tata AIG offers the MediCare line of health insurance plans for comprehensive health coverage for you and your loved ones. Our health insurance plans include a cover for pre-existing illnesses. However, the cover is activated after a waiting period of three years from the start of the policy tenure.