Pre-existing Disease Health Insurance

Pre-existing Disease Health Insurance: What is Considered a Pre-existing Condition in Insurance?

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Health insurance is necessary to get the best possible medical treatment for diseases and injuries without draining your finances. However, getting insurance coverage for people suffering from pre-existing conditions is tricky simply because such people are more likely to make claims frequently, which is financially harmful to insurers.

However, many insurers offer pre-existing disease health insurance with certain conditions. Waiting period and premium loading are the two features associated with pre-existing disease health insurance. Overall, getting health insurance coverage is not impossible if you suffer from a pre-existing condition, but it is better to be well-informed to select a suitable plan.

What is a pre-existing condition?

Pre-existing disease health insurance is for people suffering from any pre-existing condition. But what is a pre-existing condition? A pre-existing condition is any chronic disease or ailment that the person has been diagnosed with at least 48 months from applying for the health insurance policy. Any medical condition for which treatment was received in the 48 months from applying for the policy also comes under pre-existing conditions. The person is required to reveal their pre-existing condition to the insurer.

Earlier, those medical conditions which were diagnosed within 3 months from the date of issuance of the policy came under the definition of pre-existing conditions. However, IRDAI amended the pre-existing disease protocols of pre-existing disease health insurance in February 2020. Now any disease or illness diagnosed within 3 months from the date of issuance of the policy cannot be treated as a pre-existing condition by the insurers.

What are the specific pre-existing conditions?

Very serious health conditions such as cancer, diabetes, liver cirrhosis, cardiac ailments, COPD, and other life-threatening conditions come under the pre-existing category. Less serious ailments such as asthma, thyroid disorders, high blood pressure, and asthma are also treated as pre-existing conditions. It is necessary to check the pre-existing conditions listed by a pre-existing disease health insurance plan before deciding to purchase it or not.

Pre-existing Disease Health Insurance-Cardiac Ailments
Cardiac Ailments
Pre-existing Disease Health Insurance-Chronic Kidney Disease
Chronic Kidney Disease
Pre-existing Disease Health Insurance-Diabetes

Some common conditions are included under pre-existing category by all insurance companies. However, certain ailments and diseases may or may not be listed by the insurer.

Waiting Period

Any pre-existing disease health insurance plan has a waiting period. During the waiting period, the policyholder cannot file claims for compensation of medical expenses incurred on the treatment of any pre-existing condition listed by the policy. The coverage for the pre-existing conditions starts only after the termination of the waiting period.

Pre-existing Disease Health Insurance-Waiting Period

The waiting period of pre-existing disease health insurance is usually between 2-4 years from the date of issuance of the policy. The waiting period varies from insurer to insurer. The waiting period can be reduced either by paying more premiums or opting for a co-payment plan in which the policyholder pays a certain percentage of the claim amount from their own resources. 

Premium Loading

Premium loading is the extra amount added to the premium, which reduces the waiting period, ensuring quick coverage. The loading amount compensates the insurer for the risk it takes for insuring the policyholder who is already suffering from a long-term condition.

The insurer can do premium loading of pre-existing disease health insurance only at the time of selling the policy after determining the pre-existing disease. The insurer cannot do premium loading for any disease which is diagnosed after the issuance of the policy. 

In case of critical illnesses or diseases, the insurer can load the premium and increase the waiting period

Things to Determine and Be Aware of With Regards to Pre-Existing Disease and Health Insurance

  • Identifying pre-existing conditions is important prior to purchase pre-existing disease health insurance. Minor ailments such as cough, cold, and fever are not pre-existing conditions, and not every disease is a pre-existing condition. Thus, you need to check the list of pre-existing conditions made by the health insurance provider and identify whether you suffer from any of the listed ailments or not.
  • Disclose the details of health issues you may be suffering from to the insurer providing pre-existing disease health insurance. If the insurer finds out that you are suffering from a pre-existing condition that you did not disclose at the time of treatment, your claim will be rejected.
  • The insurer can ask for a complete medical check-up prior to providing pre-existing disease health insurance. This is a useful step because the doctor can detect any pre-existing condition you may not know about.
  • You must be aware that pre-existing disease health insurance is not applicable for short-term health conditions. Thus, even if you are susceptible to cold and flu and other minor ailments necessitating frequent visits to the doctor, the insurer will treat only the chronic conditions having a long-term impact on your health, if any as pre-existing.
  • As per IRDAI guidelines, an insurer has to accept or reject a claim regarding coverage of a pre-existing condition within 30 days from receiving the claim request. Furthermore, the insurer cannot reject the claim for compensation of medical expenditure for a pre-existing disease if the policyholder pays the premium for 8 years.

How to choose pre-existing disease health insurance?

Compare Pre-Existing Disease Health Insurance with Conventional Health Insurance

Pre-existing disease health insurance plans charge more premiums as compared to conventional health insurance plans. However, you can compare the health insurance plans covering pre-existing conditions offered by multiple health insurance providers to land a plan that suits your pocket. But there should not be any compromise regarding the coverage amount and the benefits.

Consider Waiting Period in Pre-Existing Disease Health Insurance

The waiting period of pre-existing disease health insurance is not fixed and varies from insurer to insurer. The waiting period can be 2 years or can be as long as 4 years, and few insurers offer waiting periods of less than 2 years. Consider the waiting period which suits you and opt for an insurer accordingly.

Co-Payment in Pre-Existing Disease Health Insurance

Paying a higher premium or opting for a co-payment plan to reduce your pre-existing disease health insurance is a suitable course of action if you cannot wait long for coverage and such an arrangement does not harm your finances.

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