Group Health Insurance Cover Pre-Existing Conditions

Does Group Health Insurance Cover Pre-Existing Conditions?

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Health insurance plans are necessary. Medical emergencies can occur at any time, and you should have health insurance to cover the bills. Almost all insurance companies offer health insurance plans at reasonable premiums. Individual health insurance plans provide several benefits, including pre-existing disease coverage. However, if you work at a corporate organization, you will be covered with group health insurance. Most employers offer their employees’ group health insurance coverage as part of their employee benefits. Such health insurance plans do not only cover the employee’s needs but can also include their family members. 

For pre-existing conditions, however, even the best health insurance comes with certain limitations. You will not be able to claim health insurance without waiting for about 4 years. That is the usual waiting period for pre-existing conditions. However, some new-age companies like ours have managed to bring this waiting period down to 2 years for those with diabetes, hypertension, and cardiac conditions.

However, for group health insurance plans, the benefits are not always so extensive. They might not be enough to cover all medical costs. Some group health insurances do not even include pre-existing illnesses. However, this depends on the insurance company and your employer. Certain insurance companies offer coverage for pre-existing medical conditions with group health insurance from day one.

What Are the Usual Conditions Placed on Pre-Existing Diseases?

Health insurance companies are usually not willing to provide cover for pre-existing illnesses. This is because those with pre-existing ailments are more likely to file a significant amount of claims and thus the financial risk for the insurance company will be higher. Due to this reason, health insurance companies place certain conditions and a waiting period on pre-existing disease coverage. These conditions are discussed in the following points. 

  • Before allowing you to buy a health insurance policy, the insurance company will require you to undergo a few medical tests. These tests will determine how critical your condition is. Depending on the test results, the insurance company will decide whether or not they will sell the policy. 
  • There is a waiting period of approximately 4 years placed on every health insurance policy for pre-existing diseases. Even top health insurance plans have waiting periods. You will not be able to get any benefits from the insurance company during this period. 
  • Certain health insurance companies reduce the waiting period. For senior citizens, health insurance companies offer immediate coverage during medical emergencies. This is a recent addition that health insurance companies have introduced. However, the cost of these policies is very high too considering the risks that come with both old age and a health condition.

The group health insurance plans offered by employers often do not require the employees to test for pre-existing diseases. Since it is a general insurance plan available for all employees, there is no need for each employee to get any tests done. But this is not exactly good news. These health insurance plans might not offer coverage for pre-existing conditions. If you do not read the fine print then it might be too late by the time you need financial assistance. Group health insurances come with many stipulations, and they extend to pre-existing medical conditions coverage as well.

When Do Group Health Insurance Policy Cover Pre-Existing Conditions?

Group health insurances allow you to add family members or dependents to the plan. Such a group health insurance is known as a family floater health plan. You can include your parents and other family members, and their medical bills will be covered by the plan. For pre-existing diseases, mediclaim policy often provides some coverage. However, it is limited and often does not provide much relief. You will get coverage of pre-existing conditions under the following circumstances:

  • There is an option for co-payment. According to the co-pay clause in health insurance, the insurance company will not pay for all medical bills. You will have to pay for certain hospitalisation charges. 
  • You agree to pay a part of the room rental charge. Room rent charges can be exorbitant. If your group health insurance policy provides pre-existing illness coverage, then you might need to pay some of the room rent. 
  • If there are no dependents or family members added to the plan. Some group health insurances offer benefits for pre-existing conditions coverage if no family members are sharing the plan. 

Group health insurance plans that have the co-pay clause or offer room rent capping often require you to pay more. Although the premiums are borne by the company, you might have to cover a part of the medical costs. The actual financial assistance ultimately becomes quite insufficient.

Would a Group Health Insurance Policy Be Enough if You Have Pre-Existing Conditions?

You can opt for pre-existing disease coverage with group health insurance but if you don’t have an individual health cover, the group cover would not be enough. A combination of health insurance plans will offer extra coverage. 

Apart from having two health plans, you can also buy a top-up or super-top plan to complement your group health insurance if you think the benefits are not enough for you. If your pre-existing diseases are not critical and do not require frequent hospitalization, then your group health insurance offered by your employer might be enough. However, if you have elderly family members then it is unwise to be dependent on just group health insurance. Top health insurance plans for individuals will include better benefits for pre-existing diseases, especially for senior citizens.

If you are looking for a health insurance policy that covers pre-existing diseases, then do your research well. Look through all conditions and check the benefits available, especially if it is a group health plan. Doing thorough research will help you determine that the policy is suitable for your medical requirements. Additionally, looking for a plan that actually covers your primary healthcare needs like doctors, medicines, tests, nutrition, etc. might be a good idea as there are major expenses when it comes to managing a chronic health condition.


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