Pre Existing Disease in Health Insurance
  • Impact of PEDs on your Health Insurance
  • Key Factors to Remember
  • Do's and Don'ts

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Pre Existing Disease in Health Insurance

The value of purchasing a comprehensive health insurance policy is underestimated by the people. They rely on the money and insurance provided by their employers. However, in today's world, the cost of medical expenses is rising, which is not economical for you. As a result, it is recommended that you and your loved ones should be covered with a suitable Health Insurance plan.

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Does Health Insurance cover Pre-Existing Diseases (PEDs) that you already have? Certainly not. That is why buying Health Insurance early in life is recommended. This not only ensures a lower premium but also ensures that you get better coverage because the risks of catching diseases are lower at a young age. This article will tell you about pre-existing diseases and health insurance.

What is a Pre-Existing Disease?

Pre-existing diseases are those medical conditions that an insured already has when they buy a new health insurance policy. The pre-existing disease is defined by IRDAI as a) any condition, ailment, injury, or disease diagnosed by a physician within 48 months of the policy's effective date or reinstatement, or b) any medical advice or treatment recommended by, or received from, a physician within 48 months of the policy's effective date or reinstatement.

How Does Pre-existing Disease Impact Your Health Insurance Coverage?

Insurance is a concept in which an health insurance company provides financial support if something unfortunate happens to the policyholder as per the terms and conditions. If a person already has a pre-existing disease then the chances of raising a claim increase. As a result, Health Insurance Companies are reluctant to cover pre-existing conditions. Some Insurance Companies may cover them as per terms & conditions and charge a higher premium for them.

Why is it important to Declare Pre-existing disease?

You might be asking whether it's even necessary to disclose your pre-existing disease. However, in this circumstance, it's preferable to be completely transparent. Examine your medical records to be sure you've covered all of the illnesses and treatments you'll require. If you do not disclose your pre-existing disease to your Insurance Company and they discover it later, they will reject your claim. So, rather than not declaring your PED, it's preferable to wait for a time and get it covered.

Effects of a Pre-existing Disease on Your Health Insurance

The following is a list of the possible effects of having a pre-existing disease on your health insurance policy.

  • Premium LoadingThe premium will be on the higher side because the Insurance provider is taking the risk of covering a pre-existing condition. This premium loading is only applicable at the time of Insurance Purchase. It cannot be charged again if the policy is renewed without interruption.
  • Waiting PeriodThis is the time frame for which you must wait for your pre-existing diseases to be covered by your Insurance policy and It depends on the insurance provider who is providing the policy.
  • Premium Loading + Waiting PeriodIn some cases where you will charge a higher premium and have a long waiting period before covering an illness.
  • Medical Check-upIf you have a pre-existing disease, your Insurance company may require you to undergo a medical examination. The Insurance Premium will be based on the results of the tests. If the results are unfavorable, the insurance company may refuse to offer a policy.
  • Permanent ExclusionThe insurance provider may refuse to cover you If you have a pre-existing disease. You have to agree that the mentioned pre-existing disease in the policy agreement is a permanent exclusion in the policy. By doing this, you will be uninsured against your pre-existing diseases, & will be covered for other health scenarios if the policy's terms and conditions are met.
  • Policy DenialThe insurance company has the right to refuse to offer you the policy because of pre-existing diseases. They will deny your application to buy a Health Insurance Policy in such instances.

How to Buy Health Insurance for Parents Who Have a Pre-Existing Illness?

Purchasing health insurance for senior citizens with pre-existing conditions might be challenging. The following is a process to purchase Health Insurance for the elderly.

  • You can buy it via an online or offline medium.
  • The Insurance Company will ask you to undergo medical tests.
  • After the completion of the tests, the company's underwriting team will analyze the results and notify you of the status.
  • The Insurance Company may ask you for a higher premium or refuse to issue the policy.

Do's and Don'ts in case of Pre-existing Diseases

  • Do Share Information About Pre-existing Diseases With InsurerWhen communicating with the Insurance Company, be open and honest. If the Insurer asks you about your medical history, be honest.
  • Do Get A Check-upGetting a health check-up on your own is a smart idea. It will notify you if you have any existing diseases and will assist you in taking appropriate action.
  • Don't hide InformationBe open and honest with your insurer. Don't hide any information about your medical history.
  • Don't Fail To Compare Plans Before BuyingIf an Insurance Company refuses to sell you a policy or charges you a high premium to cover a pre-existing disease, you can do some online research and look into alternative choices.

Things You Should Know About Pre-existing Conditions

Here are a few key factors to remember about pre-existing conditions and Health Insurance.

  • Different Insurers Have Different PoliciesWhen it comes to pre-existing diseases not all companies follow the same set of rules. Some insurers may cover pre-existing diseases, while some may not. Some may have a shorter waiting period, while others may have a longer waiting period. Therefore, before buying the plan, read carefully the terms & conditions.
  • Every Doctor Visit is Not CountedCommon cold and cough will not count as a Pre-Existing diseases. It's not a problem to go to the doctor to get your headache treated. However, if you've had the headache for a year and are taking medicine, you may have pre-existing diseases.
  • Hiding A Pre-existing DiseaseTo avoid hassles during claim settlement, it's preferable, to be honest, and transparent with the insurance company about pre-existing conditions.
  • Non-Disclosure may result in Claim RejectionNon-disclosure of a pre-existing condition can result in policy cancellation or dishonoring of claims for such diseases. Claim rejection can be disturbing for you at the time of need. So, always disclose your PEDs to your Insurance provider and always be honest with them.

Written By : Naval Goel

Last Updated : October, 2021

Naval Goel is the CEO & founder of Naval has an expertise in the insurance sector and has professional experience of more than a decade in the Industry and has worked in companies like AIG, New York doing valuation of insurance subsidiaries. He is also an Associate Member of the Indian Institute of Insurance, Pune. He has been authorized by IRDAI to act as a Principal Officer of Insurance Web Aggregator.

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