Pre-Existing Diseases in Health Insurance

If you are looking to purchase a health insurance cover, and you have a pre-existing disease, you may have numerous questions. These will probably pertain to whether your health insurance cover will apply to expenses related to this disease, and how this will affect the premium you will have to dole out.


To be clear, a pre-existing disease does not refer to an illness you may already have when you first purchase your health insurance. Rather, it refers to a comprehensive look at your family history and will ascertain whether there are certain medical conditions that are hereditary in your family – such as diabetes, heart ailments, surgery, and medication.


Before purchasing a health insurance policy that covers pre-existing diseases, your insurer will check for all details that fall under the category of ‘pre-existing disease’ and will verify your medical history in alignment with these details.

List of Pre-Existing Diseases in Health Insurance (Add IRDA)

As per the latest amendments made by the IRDAI, the following are the pre-existing disease list:


  • Diabetes

  • High Blood Pressure

  • Asthma

  • Thyroid

  • Sleep Apnea

  • Lupus

  • COPD

  • Atherosclerosis

  • Cancer

How Can Pre-Existing Diseases Be Covered?

If you have a pre-existing disease, do not fret, you can still purchase a pre-existing disease cover health insurance. The only procedural requirement, in this case, is that you will have to wait out the waiting period that your insurer will prescribe. Once you declare the list of such conditions that you have, you must note that any claim for them during this waiting period will be rejected. The usual waiting period is 4 years, and post that, you can file claims for expenses pertaining to your pre-existing disease.


Why Insurance Companies Dislike Pre-Existing Diseases?

As is apparent, insurance companies dislike issuing pre-existing disease health insurance, simply because those with such diseases possess a greater likelihood of filing a claim. This will thus directly impose a higher financial liability on the insurance company. While it is not always possible to predict the occurrence of a disease in the future, the existence of a pre-existing disease works against the insurance company’s motive of running a profitable business model.

Don’t Fret as Different Companies Provide Different Policies

If you have a pre-existing condition, while it may be difficult to buy health insurance, it is not impossible to do so. With there being a wide range of insurance providers in the market, and not all holding such a rigid stance on the same, you can choose from those that only consider your recent medical history – that over the last few years.

Disclaimers to Keep In Mind

If you have a pre-existing disease, securing a health insurance policy may prove difficult, including the refusal by the insurance company to pay/reimburse your medical bill, or even cancellation of your claim or cover. Hence, before purchasing a pre-existing disease cover health insurance, make a note of the following:


  • Differing Policies

Not all insurance providers are the same, and while some insurance providers will take into consideration your entire medical history, there are many that will only take your recent medical history into consideration.


  • Hiding Pre-Existing Illness

You must abstain from hiding any pre-existing disease, as your claim can be rejected if this is revealed during your treatment.


  • Every Doctor Visit is Not Considered

Your insurance provider will not consider short-term illnesses and doctor visits pertaining to the same, until and unless they have long-term repercussions on your health.


  • Pre-Existing Diseases Can Be Covered

Pre-Existing diseases are covered by certain insurers – but usually involve a waiting period. Only once the waiting period is over, will the insurer cover expenses such as doctor fees, medication, and hospitalisation charges.


Read more: Waiting Period in Health Insurance

  • Working Around the Waiting Period

In the case of an individual health plan or a family health insurance plan, a waiting period is levied. This waiting period often depends on your pre-existing condition, as well as its severity and duration. Some insurers do offer you a reduction in the waiting period, on the payment of an extra premium, while some do offer you a co-payment for these conditions.

New Regulations of PEDs by IRDAI

The Insurance Regulatory and Development Authority of India (IRDAI) made changes to the definition of PEDs in September 2019 – making way for the inclusion of diseases that were diagnosed within 3 months of buying a health insurance plan. As per the amendments, insurance providers can no longer exclude illnesses that were previously not included in the list.

You Have The Responsibility to Disclose Any PEDs

When buying a health insurance policy, you are legally required to disclose any pre-existing diseases that you may have. If you fail to do so, your claim will be in violation of the “disclosure of information norm”, and your insurer is allowed to reject any claim you make for expenses pertaining to the same.


While purchasing health insurance is vital, before doing so, make sure that you do adequate research on the various insurers offering pre-existing disease cover health insurance – including the waiting period, premium, and terms and conditions. Visit Finserv MARKETS today, to learn more about the same.

Best Health Insurance Plans Available at Finserv MARKETS

FAQs on Pre-Existing Diseases in Health Insurance

  • ✔️Can a Pre-Existing Disease be covered under a Standard Health Plan?

    Yes, while a pre-existing disease can be covered under a standard health plan, it comes with a waiting period of two to four years.

  • ✔️What is the waiting period? How long will it last?

    The waiting period is two to four years.

  • ✔️What if I am unaware of a pre-existing health condition and fail to report it?

    Being transparent while buying a health insurance policy is important. However, if you are unaware of a pre-existing health condition and fail to report it, your claim stands to be rejected. Thus, it is vital to undertake a health check-up before purchasing your health insurance policy.

  • ✔️Does a pre-existing disease have an impact on the premium I will have to pay?

     Expenses related to them are not covered in the first few years of the policy and will also result in paying a slightly higher premium.

  • ✔️Can I buy health insurance for my parents who have pre-existing health conditions?

    Yes, you can buy health insurance for your parents who have pre-existing health conditions. To do so, they will have to undergo a medical check-up and can be covered under the plan, but with a waiting period, co-pay, and at an extra premium.