Bajaj Markets

Pre Existing Conditions In Health Insurance

For many health insurance policyholders, the term “pre-existing disease” gives them the jitters. Several questions start stressing them out. Will a certain condition be covered? How heavy will the premium be? How long is the waiting period?

These are just some of the hundreds of questions and factors we look at when buying a health insurance plan. But what is a pre-existing disease? Let’s take a look at the definition to understand what we’re dealing with. This is particularly important to policyholders with family health insurance.

Don’t mistake pre-existing diseases (PEDs) as an illness you have when you first buy the policy. It’s not as simple as that. It’s complex and extensive. A pre-existing disease also includes a thorough medical history of a condition running in your family. It ranges from heart attacks, diabetes, prior hospitalizations, surgeries, medications, signs and symptoms for any disease or illness. The insurance company you choose will want to know every detail of all diseases and conditions you’ve had in the past. All these falls under the term “pre-existing disease.”

Insurance Companies Dislike Pre-Existing Diseases

The reason behind this is pretty obvious but is a fact you must know. The harsh truth is insurance companies are a for-profit business. So insurance providers will be apprehensive in providing health insurance plans to people suffering from pre-existing diseases. They pose higher financial risks to insurance providers because they are likely to file a claim. Of course, it is never easy to predict a medical condition in advance. But insurers are aware or want to know if policyholders may be suffering from health issues.

Don’t Fret as Different Companies Provide Different Policies

It is challenging but not impossible to get a health insurance plan or family health insurance if you have a pre-existing condition. Not all insurance companies are the same. Some insurance providers consider your entire medical history to determine PEDs. Others consider your medical history only in the past few years.

Disclaimers to Keep In Mind

Bear in mind that every insurance company has their own notion of a “pre-existing disease.” So, read your policy and your health insurance company’s literature carefully to know what’s included. The company will usually investigate the past five to ten years of your medical history.

Pre-Existing Diseases Can Be Covered

As stated before, different companies offer different plans. It is false to think pre-existing diseases are not covered by insurance providers. What exists instead is a waiting period for pre-existing diseases. During this time, you need to wait until your specified illnesses will be covered. You must disclose these specified illnesses that you have a high possibility of being diagnosed with. Any claim made to cover the specified diseases during this period will be rejected. So, doctors’ fees, medicine costs, and hospitalization to treat PEDs are not covered until after the waiting period ends. But some policies by certain insurance companies do offer coverage to PEDs a policyholder might have or get within the waiting period. The health insurance policies on Finserv MARKETS come with waiting periods of 3 years for PEDs, which is low compared to the usual 4-year waiting period in the market.

New Regulations of PEDs by IRDAI

In September 2019, the Insurance Regulatory and Development Authority of India (IRDAI) changed the definition of PEDs. They decided to include diseases diagnosed within 3 months of buying any health insurance plan. This definition was an added clause to the PED definition by the IRDAI. The expansion of the definition clarifies that insurance providers cannot exclude several illnesses that were previously not covered. Any disease or condition diagnosed after the 3 month period will be covered. The health insurance policies available on Finserv MARKETS cover diseases diagnosed or contracted after the first 30 days of the policy tenure.

You Have The Responsibility to Disclose Any PEDs

You are required to disclose any pre-existing disease at the time you buy a health insurance plan or family health insurance. If you refrain from disclosing it, then the PED diagnosis will be considered a non-disclosure/misrepresentation/non-declaration. Your claim will formally be considered a violation of the “disclosure of information norm.” The insurer can refuse to cover any disease during the policy tenure if the illness is proved to be a pre-existing disease not disclosed when you buy the policy. They will outright reject claims to cover any costs throughout the policy term.

To conclude, you can buy a health insurance plan or family health insurance if you have been diagnosed with a pre-existing disease. Different companies have different policy options. So, get informed to find the best health insurance policy. based on your medical history. Make sure to disclose any past health issues and understand the waiting periods of different providers. This helps you know what you’re in for when deciding on the right company for you.

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