How to Avail the Best Health Insurance Plan with Pre-Existing Disease?


How to Avail the Best Health Insurance Plan with Pre-Existing Disease?

Increasing healthcare costs and a rise in lifestyle diseases are factors that have pushed having health insurance to the top of one’s priority list. Having comprehensive health insurance is indeed a necessity, no matter what age group you belong to. The pandemic was a wake-up call for many, and the health insurance industry is seeing a change, though slowly, yet steadily. There are still many who have some concerns about health insurance. A common myth that surrounds health insurance is that if you are suffering from an illness, you cannot opt for a health plan. Some people also believe that having health insurance when you have an illness is very expensive.

Is that really true? Can you buy health insurance if you are suffering from an illness? Is it worth buying an expensive health insurance policy? If these questions have been hovering over you, you are at the right place. Read on as we discuss everything you need to know about health insurance plans when you have any pre-existing diseases.

Pre-existing Diseases in Health Insurance

PED or pre-existing diseases are the health conditions that the individual (who is going to buy the health insurance policy) already suffers from, before buying the policy. To be more precise, pre-existing diseases are diseases that were diagnosed 48 months (or less) before one buys the policy. There can be many examples of pre-existing diseases, such as diabetes, cancer, high blood pressure, asthma, etc.

Now that we know what pre-existing diseases mean in health insurance let us first answer some of the most common questions:

Can I buy health insurance if I am suffering from an illness? 

It might come as a pleasant surprise to you, but yes, you can buy health insurance even if you are suffering from an illness. However, the coverage that you receive might depend on factors like your insurance provider, the plan you choose, the sum insured, and, of course, the severity of the disease.

There are a number of health insurance plans by Care Health Insurance that are specifically designed for people with pre-existing illnesses.

Is it worth buying a health insurance policy when I suffer from a pre-existing disease? 

The premium that a 30-year-old healthy male has to pay will typically be lower than the premium that is paid by a 35-year-old male who suffers from diabetes. However, a higher premium must not understate the importance of having a health insurance plan. The coverage that you can receive from the plan makes the premium worth it.

It is generally recommended that you invest in a suitable health insurance plan at a young age. The main reason is that most young individuals are healthy and typically do not suffer from too many age-related problems. Buying insurance in your 20s is, therefore, a great idea. Rather, when you know that a particular illness runs in your family, it is all the more prudent to invest in a suitable plan. For example, if both your parents have diabetes, you should try going for a plan that offers a comprehensive coverage for diabetes, well in advance.

Having health insurance becomes all the more important when you are suffering from a pre-existing disease. You could be more prone to numerous other illnesses and may need more health care. Without proper coverage, a trip to the hospital can burden your pockets much more than the premium.

My illness is not severe, do I need to inform the insurer about the same?

Yes absolutely. Being honest with your health insurer is extremely important. Even if your illness is not severe it is mandatory for you to discuss the same with your insurance provider. Not doing so can lead to a claim rejection and also put you in legal trouble. Even if there is no pre-policy medical screening, do not hide or miscommunicate any information related to your health.

Waiting Period in Health Insurance

The waiting period is the time period during which a claim cannot be raised. It is an important component of health insurance, especially when it comes to pre-existing diseases.

While different insurance companies have different ways of dealing with pre-existing diseases, every company has a waiting period clause in the health insurance that they provide.

1. Initial Waiting Period

Most policies come with a 30-day waiting period for all illnesses. This means that before 30 days of policy purchase, a claim cannot be raised. However, accidental injuries that require hospitalisation of 24 hours or more are covered from day 1. 

2. Specific Waiting Period

Health insurance also covers illnesses such as kidney stones, hernia, Parkinson’s, etc. However, there is a specific waiting period of 24 months, and coverage is available only after serving this period. 

3. Pre-Existing Disease Waiting Period

People who have a pre-existing disease, for instance, hypertension or diabetes, need to serve a waiting period of 48 months. Only once this period is over would you be able to raise a claim for these illnesses. Keep in mind that other illnesses and injuries will be covered as per the policy coverage.

>> Also Read: Boost your Health Insurance Coverage with Add-on Covers

What’s More on Pre-existing Diseases in Health Insurance?

The Insurance Research and Development Authority of India introduced the following changes in the way health insurance deal with pre-existing diseases:

1. Recognising Symptoms

In the year 2020, IRDAI brought some updates on pre-existing diseases in health insurance. The apex body ruled that an illness that presents its symptoms or is diagnosed within 3 months of policy purchase will be treated as a pre-existing disease.

2. 8-year Moratorium

Once the health insurance premium has been paid for continuous coverage of 8 years, health insurance companies will not be allowed to contest a health claim raised by a policyholder. The IRDAI mandated a ‘No Look Back’ clause for all policies that were purchased or renewed after 1st April, 2021 unless there’s proven fraud. This 8-year period, known as the Moratorium Period, will be subject to limits, co-payments, and deductibles as per the policy terms and conditions.

Buying Health Insurance with Pre-existing Diseases 

If you are planning to buy health insurance for yourself or someone with pre-existing diseases, keep the following things in mind:

1. Do not try hiding any information on your pre-existing illnesses. Declare them correctly and opt for appropriate coverage.

2. Waiting period is crucial in health insurance, the sooner you finish it, the better for you. Thus, try buying the right plan early in life.

3. Make sure to renew your health insurance policy on time. When you miss renewing the policy and end up buying a fresh policy you will have to serve a fresh waiting period.


Having a pre-existing disease should not deter or demotivate you from buying health insurance. Rather, having an illness should be a reason that makes you invest in suitable coverage all the more. Buying a health plan early in life will help you serve the waiting period early on. Just make sure you keep renewing it on time so that your acquired benefits do not go down the drain.

Disclaimer: The above mentioned information is for reference purposes only. Kindly consult your doctor in case of any emergency or doubt.

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