Group Insurance Cover Pre-Existing Diseases

Does Group Insurance Cover Pre-Existing Diseases?

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A pre-existing disease, or PED, is a medical condition that a person already has before purchasing insurance. Hypertension, Diabetes, and asthma are just a few examples. Getting pre-existing disease coverage can be a source of concern as the health risk associated with these individuals are very high. Group insurance can be one of the ways to get covered seamlessly, provided your organization is offering one.

Pre-existing diseases (PEDs) can be easily covered under group insurance coverage since the policy is purchased by a company rather than an individual and thus at a lower risk of fraud. In general, policy buyers with PEDs must go through a medical screening from the insurance company, and insurers have a bigger financial risk when it comes to PEDs. As a result, while purchasing health insurance coverage, insurers might not even cover these disorders in the first few years. As a result, looking at specific health policies that include PED in health insurance can be beneficial.

What is a pre-existing disease?

A pre-existing disease, or PED, is a medical issue which a person has already been diagnosed with before purchasing insurance. Hypertension, Diabetes, and asthma are just a few of the most common examples of pre-existing or chronic diseases.

Pre-Existing Disease in A Group Mediclaim Policy

IRDAI defines a pre-existing disease as any condition, ailment, injury, or disease diagnosed by a physician within 48 months of the insurer’s policy’s effective date or reinstatement, and for which medical advice or treatment was suggested by, or received from, a health professional within 48 months of the insurer’s policy’s date of issuance or reinstatement.

When It Comes to Group Insurance, How Do Pre-Existing Conditions Get Covered?

Suppose you (or anybody else looking for health insurance) purchase an Individual Health Insurance Policy. In that case, you may be forced to take a few tests before the insurer offers you a policy and charges you a premium. A test is not required under a Group Health Plan, though.

Employee insurance is a generic plan with the possibility of customizing it individually by purchasing top-up plans or add-on covers. According to the rules and circumstances of Group Health Insurance, pre-existing disorders are normally covered automatically. Before even being covered by the plan, employees may be forced to disclose these pre-existing conditions. If you decide to go for a top-up insurance plan to supplement your group coverage, depending on the severity of the condition, you may be required to undergo a medical screening or tele-underwriting before your insurance is approved.

Benefits of group insurance for employees

For an employee enrolled by a group health plan, several aspects can be useful.

The following are the details:

The Advantage of Group Health Insurance

  • Mostly, the organization you are working for will cover the expenses
  • The plan could cover your entire family
  • It is usually available without any waiting period
  • Pre-existing diseases are covered (generally from day one)
  • Covers you for Covid-19 related hospitalizations
  • Many plans have a provision for covering OPD treatments
  • Not only do claims get processed faster, they have almost zero chances of being rejected

Other Advantages

  • Group insurance now covers a range of vaalue-added wellness needs – including telemedicines
  • It has started covering mental health and fitness – two crucial aspects of health
  • Many new companies, like ours, offer employees lifelong continuity – the chance to continue their group cover as an individual plan
  • Digital access to healthcare needs and dedicated support

Should the pre-existing diseases waiver be chosen?

Suppose your desired employee health plan does not include pre-existing disease coverage as part of the base policy. In that case, you should select a pre-existing waiver to ensure that your employees are covered comprehensively.

If, for instance, the majority of the employees are over the age of thirty, they may have or be at risk for lifestyle-related pre-existing disorders. It would be prudent to insure them for such illnesses in such a situation, even if it means a slight increase in the premium paid.

What is the importance of a group insurance plan?

Let us explain why group insurance is important for both employers and employees.

How Does Group Insurance Benefit the Employer?

The importance of corporate insurance for the employer is highlighted in the following aspects.

An Increase in Goodwill

A people-first company will provide its employees with a comprehensive health plan. As a result of such efforts, the company’s reputation will improve.

Improved Employee Retention

When workers feel valued and cared for, it is likely to get a direct and beneficial impact on their commitment to the organization.

Increased Productivity

Offering healthcare benefits make employees feel valued and push them to put in their extra, leading to better work cultures and improved productivity.

How Does Group Insurance Benefit the Employee?

Here are a few aspects that show the importance of corporate insurance for employees:

Group Insurance Employee Benefits

Free Insurance Coverage

Group health covers are generally paid for by the company, so it is essentially free coverage for the employees. This is also the reason why group insurance often becomes the first health insurance youngsters get.

Better Customer Support

Customer service for health insurance, in general, has never been too good. It becomes especially crucial at the time of filing claims. A group health insurance always has better service because the organization itself pushes and ensures better service for their employees.

Lesser Worries About Health Expenses

Considering the situation today, health expenses have become a matter of concern, thanks to the rising costs. Having group insurance gives the employees one less thing to worry about.

Can pre-existing diseases be covered from day one in group insurance?

Yes, pre-existing conditions can be covered right away. From the first day of the policy, you could cover the employees’ pre-existing ailments with a Group Medical Plan. Because a Group Medical Cover is customized, please discuss and understand the policy’s coverage and exclusions before purchasing.

This means that the diseases do not have a waiting time for being covered. Employees, for example, can file a hospitalization claim without having to wait for a specified period to pass. Is pre-existing disease coverage included in all group policies from the start? It’s possible that such a provision isn’t available in every policy, and some companies may sell it as an add-on cover. Before purchasing insurance, it is recommended that you review the policy specifics.


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