Health insurance often brings up an important question for many people: what happens if you already have a medical condition? Pre-existing diseases play a key role in how your policy works, affecting coverage, waiting periods and premiums. Understanding how insurers handle these conditions helps you make clearer, more confident choices.
This guide will walk you through the pre existing diseases list in health insurance and what it means for your coverage and peace of mind.
What are pre-existing diseases in health insurance
Pre-existing diseases are medical conditions you already have before buying a health insurance plan. In India, a condition is considered pre-existing if you were diagnosed with it or received treatment for it at any time in the four years before your policy starts.
This includes ongoing illnesses, lifestyle-related conditions or older issues that still require attention. Insurers ask for details of past diagnoses, treatments and ongoing medication when you apply, which helps them identify conditions included in the pre existing disease list in health insurance and structure your coverage accordingly.
List of common pre-existing diseases covered by insurers
Insurers usually cover common pre-existing diseases that frequently appear in health records. The list of pre existing disease in health insurance often includes diabetes, high blood pressure, thyroid disorders, asthma, high cholesterol, obesity-related issues, arthritis, cardiac conditions, COPD and kidney-related illnesses.
The exact list can vary between insurers, but these conditions form the core pre-existing disease coverage in most policies, like health insurance plans.
How insurers evaluate pre-existing health conditions
Insurers assess pre-existing conditions to understand your health and structure your policy. This involves reviewing the medical declaration form, where you provide details of past diagnoses, treatments and ongoing medication.
Some applicants may need basic medical tests to assess their current health, and insurers may check past reports or prescriptions to see how long a condition has existed and whether it is well controlled. Based on this information, applicants are placed into risk categories, which can affect premiums and the waiting period.
Insurers use the health insurance pre existing disease list to determine which conditions require special consideration. In some cases, they may also suggest additional coverage, such as critical illness insurance, for broader protection.
Waiting period for pre-existing diseases
The waiting period is the time during which you cannot file claims for a pre-existing disease after buying a health insurance plan. There are three main types. The initial waiting period usually lasts 30 days from the start of the policy and applies to most illnesses except accidents.
Specific disease waiting periods apply to certain conditions, such as cataracts or hernia and typically range from 1-2 years.
The pre-existing disease waiting period applies specifically to pre-existing conditions and generally ranges from 24-48 months.
Impact of pre-existing diseases on health insurance premiums
Pre-existing diseases can increase your health insurance premium because they indicate a higher risk of future claims. The final premium depends on factors such as your age, the severity of the condition and how well it is managed. Stable and well-controlled conditions generally attract lower premiums compared to unmanaged or severe illnesses.
How to disclose pre-existing diseases while buying health insurance
Always provide complete and accurate details of your health history when filling out the proposal form. Include information about past diagnoses, ongoing medication and previous treatments. Clear disclosure helps ensure smooth claim settlement and prevents disputes. If requested, provide medical reports to help the insurer assess your health accurately.
Consequences of not declaring pre-existing conditions
If you hide or misrepresent your medical history, your insurer may reject claims or even cancel your policy. Non-disclosure can affect your long-term coverage and make it harder to obtain insurance in the future.
How to choose the right health insurance plan with PED cover
When choosing a plan, look for policies with shorter waiting periods and clear terms for pre-existing conditions. Consider the premium, coverage limits and any useful add-ons. It is also important to check the insurer’s claim settlement record and hospital network. For extra protection, you may include critical illness coverage if it suits your health needs.
Conclusion
Understanding how pre-existing diseases affect health insurance helps you evaluate a policy beyond just the price. Before choosing a plan, check how it covers your ongoing health needs. A plan that properly manages your existing conditions often provides better long-term value than one chosen solely for its affordability.
FAQs
1. Can pre-existing diseases ever be covered immediately?
Most pre-existing conditions have a waiting period, but some insurers may offer partial coverage or reduced waiting periods if the condition is stable and well-managed.
2. Do pre-existing diseases affect only individual policies?
No, group health insurance for employees may also consider pre-existing conditions, but premiums and coverage rules can differ from individual plans.
3. Can I switch insurers if I have a pre-existing disease?
Yes, but your new insurer may ask for a medical history and could impose a fresh waiting period, depending on the condition and your previous policy’s duration.
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.
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