Pre-Existing Disease in a Health Insurance Plan

What is a Pre-existing Illness?

A pre-existing illness is an illness or medical condition that the insured has before purchasing a health insurance policy. As per IRDAI, if the insured was diagnosed with a disease or medical condition up to 48 months before buying the policy, it is termed as a pre-existing disease. Pre-existing conditions include all the long-term health issues ranging from high blood pressure and thyroid to diabetes, asthma, etc.

Pre-existing Diseases Waiting Period

Most health insurance plans cover pre-existing diseases after a waiting period. During this period, any claim raised for the treatment of a pre-existing disease will be rejected by your insurance provider. Usually, a pre-existing disease waiting period ranges from 2 to 4 years.

The pre-existing disease waiting period is not the same for diseases across all health plans. While some health insurance plans will have a waiting of 2 years for diseases, other health plans may cover the same disease after a waiting period of four years. It is suggested that you switch to a different insurance provider only after completing your waiting period. Doing so will ensure that it is accrued when you switch the insurer and you do not have to start your waiting period afresh.

Nonetheless, there are health insurance plans that offer a reduction in PED waiting period rider. With this rider, you can reduce your pre-existing disease waiting period by paying an extra premium amount.

Why Do Health Insurance Companies Dislike Pre-existing Diseases?

Insurance companies are apprehensive to provide health insurance coverage to people suffering from pre-existing illnesses.

Wondering why?

It is because people with pre-existing illnesses are more likely to file a claim as compared to other people. This imposes higher financial risk on the health insurance providers and therefore, they avoid offering medical insurance to people with pre-existing diseases.

It is not easy to predict sickness in advance. But people who are already suffering from health problems have a great probability of falling sick and raising a claim. Thus, health insurance companies reduce their financial burden by not offering coverage to people with pre-existing ailments.

Tips to Buy Health Insurance If You Have a Pre-existing Disease

To buy medical insurance, people with pre-existing health issues often have to undergo a pre-policy medical check-up. The results of the medical check-up will determine the premium charged by the insurance company. Pre-acceptance health check-ups could also lead to refusal from the insurer to offer the policy or reduce the policy coverage.

You must be wondering how to work around this issue?

Here is a quick rundown of some useful tips that can help you find good health insurance policy even if you have a pre-existing health issue:

1. Pre-existing Disease Coverage Can be Availed After 48 Months

It can be challenging to get health insurance coverage when you have a pre-existing health condition. However, as per the latest IRDAI guidelines, health insurance companies can consider the medical history of only the last 48 months to find a pre-existing disease. Therefore, you can buy health insurance with pre-existing disease coverage 48 months after your pre-existing disease was diagnosed/cured.

2. Do Not Hide a Pre-existing Illness

Refrain from hiding any pre-existing health issue from your insurance company at the time of buying the policy. This is essential because if your pre-existing condition is disclosed at the time of treatment, then the insurer can reject your health insurance claim.

3. Every Visit to the Doctor Does Not Count as a Pre-existing Disease-

When it comes to pre-existing diseases, health insurance companies will only take into consideration your health ailments that will have an impact in the long run. Therefore, if you are prone to flu, cough, cold or fever, then do not fret! The insurance company will not consider such short-term health issues as pre-existing ailments as do not have long-term side effects.

4. Opt for a Health Plan with a Lower PED Waiting Period

Whether you buy an individual health plan or a family health insurance plan, there is a pre-existing disease waiting period that restricts you from filing a claim for a specific period. During this period, any claim raised for such diseases will be rejected by your insurance company.

Besides, this time duration of the waiting period may differ based on the insurance policy. It also depends on the duration and severity of your pre-existing disease. Therefore, you should opt for a health insurance policy that comes with a lower pre-existing disease waiting period.

5. Avoid Health Plans with Co-Payment Clause for Pre-existing Disease Coverage

Some health insurance providers may have a co-payment clause for pre-existing conditions coverage. Under this clause, you will have to pay a percentage of the claim amount during claim settlement and the insurer will pay the outstanding amount. But not every health policy comes with this co-payment clause for covering pre-existing diseases. Hence, buy a health plan that does not come with a co-payment clause.

Summing It Up

So, even if you have a pre-existing health problem, you can still get health insurance coverage. Just make sure to check the waiting period for pre-existing diseases under your health policy.