If you are here, you have probably decided to do the smartest thing for your savings – health insurance plan. Although, you would do your share of research to find a health plan that suits your needs, you could find the fine print confusing and may need clarity when it comes to understanding coverage for pre-existing diseases or pre-existing conditions, especially if you happen to have one. Read on as we take you through everything about pre-existing diseases and their coverage under a health insurance policy.
What is a pre-existing illness?
A pre-existing disease is defined by the regulator as any condition or ailment
- That is/are diagnosed by a physician within 48 months prior to the effective date of the policy issued by the insurer 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 or its reinstatement.
- A condition for which any symptoms and or signs if presented and have resulted within three months of the issuance of the policy in a diagnostic illness or medical condition
So let’s say if you bought a health plan today but were diagnosed with diabetes prior to policy purchase, then diabetes becomes your pre-existing disease. While diabetes, asthma, hypertension, cardiac conditions, etc. are some common PEDs, something like a regular cold, cough, or mild fever or infectious diseases like dengue and malaria are not considered a PEDs.
Pre-existing diseases waiting period
Health insurance plans typically impose a waiting period for pre-existing diseases, during which claims related to these conditions are not admissible. This waiting period usually ranges from 2 to 4 years, depending on the insurer and the specific policy terms. It's essential to review the waiting period clauses in your policy document to understand when coverage for your pre-existing condition will commence.
Why do health insurance companies dislike pre-existing diseases?
Insurers often exhibit reluctance toward covering pre-existing diseases due to the heightened financial risk they represent. Individuals with such conditions are more likely to file claims, leading to increased costs for the insurance company. To mitigate this risk, insurers may implement longer waiting periods, higher premiums or even exclude certain conditions from coverage.
Tips to buy health insurance if you have a pre-existing disease
Securing a health insurance plan with a pre-existing condition requires careful consideration:
- Full Disclosure: Always disclose your medical history accurately when applying for insurance. Non-disclosure can lead to claim rejections or policy cancellations.
- Compare Policies: Different insurers have varying terms regarding pre-existing conditions. Compare policies to find one with favourable terms, such as shorter waiting periods or lower premiums.
- Consider Specialised Plans: Some insurers offer plans specifically designed for individuals with certain pre-existing conditions, providing more comprehensive coverage.
- Group Health Insurance: If available, opt for group health insurance plans, as they often provide coverage for pre-existing conditions from day one without a waiting period.
- Riders and Add-ons: Explore options to reduce waiting periods through riders or add-ons, which may be available at an additional premium.
FAQs
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Will an insurer cover my pre-existing disease from the first day of my health insurance policy?
If an insurance provider accepts your proposal post-medical evaluation, they will cover your pre-existing disease after 24 months of continuous coverage for a policy with a sum insured ₹3 lakh, and after 48 months of continuous coverage for a policy with a sum insured of up to ₹2 lahks.
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When do i need to tell the insurer that i have a pre-existing disease?
You must disclose your complete past and current medical history at the time of applying for a health insurance policy.
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Can i declare my pre-existing disease after i have bought health insurance?
No, pre-existing diseases need to be declared while buying health insurance because your policy is underwritten based on your health declaration. In case the same is not disclosed, the insurer reserves the right to cancel the policy on grounds of misrepresentation. Furthermore, they shall not be liable for claims if any.
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Is there a way to skip the waiting period for pre-existing diseases?
No, you will have to wait as per the period mentioned in your policy before we start covering your pre-existing disease.
Conclusion
To sum things up, sometimes you may genuinely forget to mention a small surgery done in the past, but this one error could cost you approval for your claim later. So, make sure you declare any pre-existing diseases or conditions when you buy health insurance. Don’t try to hide it, thinking you would be denied health insurance. It can defeat the purpose of having your health secured when your claim is rejected on the grounds of non-disclosure of pre-existing diseases. A true disclosure can prove to be a win-win situation for you as well as your insurance company.
ICICI Lombard also provides health insurance plans like Family Health Insurance, Health Booster , Arogya Sanjeevani Policy, Corona Kavach Policy, and Personal Accident Insurance which offers people the much-needed financial backup during any medical emergencies.
Disclaimer: The information provided in this blog is for educational and informational purposes only. It is not intended as a substitute for professional advice, diagnosis or treatment. Please consult a certified medical and/or nutrition professional for any questions. Relying on any information provided in this blog is solely at your own risk, and ICICI Lombard is not responsible for any effects or consequences resulting from the use of the information shared.