Now Get Health Insurance Plans That Provide Day 1 Coverage For PEDs

There is a notion that people with Pre-Existing Diseases (PED) don’t get health insurance and this is the most common reason for consumers to procrastinate buying insurance. However, that is not true. Nowadays, even if you have a PED you can easily get health insurance.

In February 2020, IRDAI clarified the definition of pre-existing disease. According to the regulator, a pre-existing disease (PED) is any condition that is diagnosed by a physician within 48 months prior to the effective date of the policy issued by the insurer or its reinstatement, or for which medical advice or treatment was recommended by, or received from, a physician within 48 months prior to the effective date of the policy issued by the insurer or its reinstatement. Diabetes and hypertension are the two most penetrated PEDs in India. 70% of people with PEDs in India suffer from diabetes and 20% from hypertension.

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About a third of customers looking to buy insurance through Policybazaar have a pre-existing disease. The most common one is diabetes which constitutes 50% of the customers with PEDs and 20-30% of people suffer from heart-related ailments. Inactive lifestyles, unhealthy eating habits, work pressure, and stress are giving rise to pre-existing diseases.
Until now, policyholders endured a waiting period before receiving the policy. Most insurers cover PEDs after a mandatory waiting period of 2-4 years.

However, keeping in mind the benefit for the consumers, insurers have now introduced plans which offer coverage for a PED from day 1 such as Aditya Birla Activ Health Enhanced-Diabetes, Star Health Diabetes Safe Plan-A, HDFC Ergo Energy Gold. There are plans which have a lesser waiting period such as Star Cardiac Care-Gold that covers pre-existing cardiac aliments from the 91st day after the commencement of the policy. Typically, plans with a lesser waiting period or day 1 coverage of PED provide coverage for diseases including Asthma, blood pressure, cholesterol-related ailments, and diabetes. 

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“The product has been well accepted by consumers because they realize that they are getting coverage from day 1. The fact that they have a PED and the condition may lead to a treatment requirement at any point of time, that is why it has been successful,” said Mayank Bathwal, CEO, Aditya Birla Health Insurance.

Out of all day 1 cover policies sold until now, 18% of customers were from larger states like Maharashtra, 11% were from Gujarat, and 10% from the national capital Delhi. Interestingly, 62% of people who bought the policy were aged above 50 years. There were more male proposers for these policies which accounted for 79% while only 21% were female proposers. Out of all PED customers, 20% take day 1 cover.

“We not only brought day 1 coverage for hospitalization but also expenses outside hospitalization. For example, a diabetic patient may need to visit a doctor, get an HBA1 C test, consult expert health coaches,” he added. ((quote_1))

Why have these plans been launched?

Traditionally, health insurance plans had a waiting period of four years which is a long time for a consumer to wait for coverage for a PED. There are a lot of expenses which are incurred during these four years. Therefore, there has been a lot of interest among consumers to look for plans with a lower waiting period or early coverage. This felt the need for insurers to launch plans that provide coverage for PEDs from day 1. Health insurance plans offering coverage for a PED from day 1 are slightly costlier than normal health insurance plans. However, if you see the overall proposition given the fact that you are covered from doctor’s consultation, diagnostic tests etc, these plans are economical.



Lastly, you need to keep certain things in mind when buying a health insurance plan if you have a PED: 

• Not all ailments are considered a pre-existing condition: Insurers only consider medical conditions and ailments which have had a long-term effect on a person’s health.
• Hiding a pre-existing condition is never a good idea: You should never hide your pre-existing condition. We often think that disclosing it may hinder our chances of getting health insurance. However, this can lead to serious consequences as your claim might get rejected if it is found out later.
• You can get coverage for pre-existing medical conditions: We often think PEDs can not be covered. However, insurers offer waiver of pre-existing conditions. Insurance companies often offer a waiting period of 2-4 years but now there are plans available that offer coverage from day 1.
• Consumers with PEDs must assess their waiting periods: Depending on the severity of your disease, you can decide whether you want early coverage or can afford to wait.
• Read the terms of the plan carefully for limitations like room rent capping, co-payments, sub-limits.
• Get plans that are issued digitally: Buying policies digitally reduced the chances of misselling and helps in create transparency. Moreover, policy issuance is faster through digital channels as you don’t have to step out of your home for a physical medical test. Policybazaar and insurers have come together to conduct telemedical and video medical so that there isn’t any need to physically visit a doctor.
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