Pre Existing Disease Health Insurance

Pre-Existing Diseases Waiting Period

As the name suggests, the pre-existing disease waiting period in health insurance plans is when you must wait before you start to utilise your policy’s benefits for the existing health conditions. It occurs from the policy’s inception date, and the policyholders can’t file a claim during this duration. The waiting period for pre-existing diseases varies from one insurance provider to another.

Types of Waiting Periods under Health Insurance Plans

There are four main types of waiting periods in health insurance plans. They include:

• Pre-existing Diseases (PED) Waiting Period: If the insured has high BP, diabetes, high blood pressure, etc., while buying a health insurance plan, these conditions will be considered pre-existing diseases. According to the plan, health insurance policies usually cover pre-existing diseases after a policyholder serves a waiting period of 2 to 4 years.
• Waiting Periods for Named Ailments/Procedures: There are specific ailments & procedures, such as joint replacement, ENT disorders, cataracts, etc., with the named ailments waiting at least two years.
• Initial Waiting Period: All health insurance plans have an initial waiting period of 30 days. During this duration, no claim is accepted except for accidental ones.
• Maternity Benefit Waiting Period: Maternity insurance benefits mothers and newborn babies. You can get coverage only after serving a notice period varying from 9 months to 36 months.

Why is it Necessary to Disclose PEDs while Buying a Health Insurance Policy?

People often make the mistake of not revealing pre-existing illnesses while buying health insurance, and no health insurance company encourages this. You must know that specific health insurance for pre-existing diseases, such as ‘Care Freedom’, offers a two-year waiting period. You can purchase this plan on an individual or a family floater basis.

Insured gets a health insurance policy based on information the insured provides to the insurer.

One should always ensure no discrepancy in the information you have provided to the insurance company in the applicant's proposal form.

The information you give your insurer is considered truthful and accepted in only good faith. In case of pre-existing diseases, you must disclose it honestly to avoid your policy from becoming null and void in the future.

Your insurance company also has the right to reject your claim, and the premium you paid will mean nothing. That’s not only what you will face if you do not disclose any pre-existing condition. You might get penalised for providing incomplete or fake information.

So, if you don’t want to face any of these difficulties, ensure you don’t hide anything while buying health insurance for pre-existing conditions or a simple health insurance plan.

Quick Facts about Pre-Existing Disease Waiting Period

• The terms and conditions of pre-existing diseases may differ from plan to plan.
• Only specific diseases are considered pre-existing under health insurance.
• For health insurance portability, you do not need to wait to complete the pre-existing waiting period.
• Reducing the wait period add-on available under our different plans can lessen the pre-existing waiting period.

Tips to Buy Health Insurance for Parents Who Have Pre-existing Ailments

If your parents have a pre-existing medical condition, there are a few things that you need to consider before you pick the right health insurance for pre-existing conditions-

• Waiting Period: In India, finding zero waiting period health insurance is impossible. Any medical insurance option you choose for your parents will have a waiting period, usually 36 months, for pre-existing diseases. Before finalising a health insurance option, select the one with a minimum waiting period.
• Sum Insured: When there is a chance of emergency hospitalisation or medical treatment arising due to the pre-existing condition, it is wise to go for a higher sum insured. One should also consider medical inflation and the high costs of surgeries before selecting an adequate sum insured option.
• Medical check-ups: Parents can get health coverage online without pre-policy medical tests. However, in some cases, the underwriter may require a medical examination.
• Affordable Premium: It is more likely that health insurance for your parents will have a marginally higher premium than for someone without a pre-existing condition. However, you will find an affordable option after carefully comparing and reviewing various plans.

Care Health Insurance offers a Care Senior plan exclusively designed for senior citizens. This plan helps you cover your parents at comparatively affordable premium rates.

Things to Consider While Buying Health Insurance Plan for Pre-Existing Diseases

Keeping some facts in mind will keep you well-informed and help you get the best health insurance for Pre-existing diseases:

• Identify Pre-existing Diseases: Minor health issues, such as cough, cold, and fever, are not pre-existing diseases. Not every ailment is a pre-existing disease. A list of pre-existing conditions is admissible for the claim under the health insurance coverage, subject to a waiting period.
• Disclose complete information: Never hide your medical condition that may affect your chances of getting a health insurance policy or lead to claim rejection if any pre-existing condition is found later.
• Pre-policy medical check-up: The underwriter may require a policy buyer to undergo a pre-policy medical check-up.
• Waiting Period: Health insurance plans with pre-existing disease coverage have a waiting period of 36 months. However, you can also opt for a reduced waiting period for pre-existing diseases as an add-on benefit offered by us at an additional premium.
• Premium: The health insurance premium will be higher due to pre-existing diseases. It is so because we are taking the risk of covering a pre-existing illness.

Effects of a Pre-existing Disease on Your Health Insurance

Understanding the effects of pre-existing diseases can help you make informed decisions while selecting the best plan for your needs:

• Higher Premiums: Insurance service providers usually charge hefty premiums to cover the additional risk for policyholders with pre-existing conditions. The severity of the condition influences the premium hike.
• Exclusions or Waiting Periods: Some policies impose waiting periods before offering coverage for a pre-existing condition. This means that the insurance may not cover expenses related to the disease for a specified duration (e.g., 1-4 years).
• Limited Coverage: Depending on the insurer, the policy might not include treatment for particular pre-existing conditions. This can be incredibly impactful if the condition needs continuous treatment or medication.
• Coverage Denial: In some cases, an insurer can reject coverage for people with certain pre-existing conditions, especially if the condition is considered high-risk (like cancer or heart disease).
• Disclosure Requirement: When applying for health insurance, disclosing any pre-existing condition is essential. If the policyholder doesn't fulfil this term, it can result in claims denial or coverage cancellation if discovered later.

By understanding the potential impact of pre-existing diseases on health insurance, you can better navigate your alternatives and pick a policy that meets your needs and health.

It is in your best interest to go for a health insurance policy at a young age so that the possibility of having any pre-existing condition is low. If you have a pre-existing ailment, you must wait through the applicable waiting period to avail of the coverage when any illness develops.

If you are looking forward to getting health insurance or a Mediclaim for pre-existing diseases, Care Health Insurance could be your best option, catering to all your needs.