Pre Existing Disease Health Insurance

Types of Waiting Periods under Health Insurance Plans

There are three main types of waiting periods in health insurance plans, which include:

PED Coverage Process To Avoid Claim Rejection

The PED waiting period is a restriction period, set by the insurer, during which claims for pre-existing conditions are excluded. Once this period is over, coverage for the declared condition begins according to the policy terms.

• Disclosure:All existing medical conditions, such as high blood pressure, asthma, or diabetes, must be disclosed to the insurer while buying the policy.
• Waiting Period:The insurer defines a specific waiting period (typically 24, 36 months) during which expenses for declared pre-existing conditions are not covered.
• Claim Rejection During Waiting Period:Any hospitalisation related to a disclosed pre-existing disease during the waiting period will be rejected.
• Coverage After Waiting Period:Once the waiting period ends and the policy is renewed, claims for declared pre-existing conditions become payable.

Note: Always review policy wording carefully and keep records up to date to ensure claims are processed smoothly when it matters most.

Can the PED Waiting Period Be Reduced?

Yes, the PED waiting period can be reduced by choosing the right plan or add-on options, There are now different options available to reduce the waiting time for existing medical conditions, allowing coverage to begin earlier.

• Specialised Plans: Some Care Health Insurance plans, such as Care Freedom, Ultimate Care, Ultimate Care Senior, Care Supreme, and more, are specifically designed for people with pre-existing diseases such as hypertension or diabetes. These plans offer optional benefits that reduce waiting periods compared to standard policies, enabling quicker access to coverage.
• PED Waiting Period Reduction Add-ons: With PED modification add-ons, the waiting period in PED insurance can be reduced significantly (e.g., 3 years down to 1-2 years), offering policyholders greater flexibility when buying insurance for pre-existing diseases.
• Instant or Early Cover Riders (Instant Cover/Instant Cover Plus): These riders offer early coverage for certain PEDs that may begin as early as Day 30 or at midnight of the policy, securing early protection against existing health issues.

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 insurance for pre-existing diseases, and no insurer encourages this. Specific plans like Care Freedom offer a 2-year period and can be purchased on an individual or family floater basis. Here’s why disclosure is critical:

• Claim Validity:Non-disclosure may result in claim denial if the insurer discovers the disease was pre-existing and not disclosed.
• Policy Approval:Insurers accurately evaluate risk based on health conditions.
• Waiting Period Clarity:Most policies have a waiting period for PEDs; disclosure ensures correct PED tracking.
• Legal Compliance:Giving false or incomplete information may cancel the policy.
• Premium Accuracy:Accurate disclosure helps insurers determine the right premium.
• Peace of Mind:Knowing that your health insurance covers your pre-existing illness ensures uninterrupted coverage for your condition.

How Does a Pre-existing Disease Affect Your Health Insurance?

A pre-existing disease (PED) can have a significant impact on your policy conditions, costs, and coverage. Understanding PED insurance and PED meaning in health insurance helps you make the right choice when buying insurance for pre-existing disease, and ensures smooth claims.

• PED Waiting Period: Most insurance plans apply a PED waiting period of 2-3 years before extending coverage for treatment associated with a pre-existing disease or pre-existing ailment.
• Higher Premiums: Because pre-existing disease health insurance involves a higher medical risk, premiums may increase based on the severity of the illness.
• Coverage Restrictions: Some health insurance plans covering pre-existing conditions may include limits or exclusions on specific treatments. Medical Underwriting: Insurers often require medical tests before policy approval, specifically for senior citizens with pre-existing ailments
• Policy Rejection Risk: In extreme cases, the insurer might deny the application if the risk is deemed too high.
• Mandatory Disclosure: Failure to disclose PED in health insurance can result in claim rejection or policy cancellation later, making transparency with the insurer essential

Common Reasons for Claim Denial in Pre-Existing Disease Health Insurance

Most claim rejections for pre-existing disease health insurance are avoidable and often result from the PED waiting period or failure to meet policy conditions. Knowing these factors in advance helps ensure smoother claim settlements.

• Non-Disclosure of Information: A leading cause of denial when an applicant fails to disclose an existing medical condition, ongoing medication or symptoms when buying the policy.
• Claim During the Waiting Period: Disclosure alone doesn’t ensure immediate coverage. Since certain health insurance policies require a PED waiting period; any claims for treatment during this period are not payable.
• Policy Exclusions: Some policies permanently exclude coverage for specific conditions.
• Incorrect or Incomplete Documentation: Errors in claim forms, missing medical documents, or inconsistent details can lead to delays or claim rejection.
• Fraud or Misrepresentation: Submitting incorrect information or inflating bills may result in immediate claim denial and possible policy cancellation.
• Lack of Medical Necessity: A claim can be rejected if the treatment or hospitalisation is found to be medically unnecessary or can be managed without inpatient care.

Tips to Buy Health Insurance for Parents with Pre-existing Conditions

Buying health insurance for parents with pre-existing diseases demands careful consideration, as age and existing health conditions affect policy benefits and pricing. If your parents have a pre-existing ailment, review the following tips carefully to choose suitable insurance for a pre-existing disease.

• PED Waiting Period: Opt for a family health insurance policy with a shorter PED waiting period, so coverage for pre-existing conditions begins earlier.
• Sum Insured: Choose a higher sum insured to offset increasing healthcare expenses caused by medical inflation.
• Medical Check-ups: Some insurers may require specific medical tests for PED coverage, particularly for senior citizens.
• Affordable Premium: Compare premiums carefully to strike the right balance between premium costs and adequate coverage for pre-existing disease health insurance.

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

To find the best medical insurance for pre-existing conditions, keep the following in mind:

• Identify Pre-existing Diseases: Minor health issues such as coughs, colds, or fevers are not pre-existing diseases. Only long-term illnesses recognised under PED in insurance qualify as pre-existing diseases and require serving a waiting period.
• Disclose complete information: Never hide a pre-existing ailment, as it may result in claim rejection or cancellation of the policy at a later stage.
• Pre-policy medical check-up: Insurers may require medical examinations to assess health risks prior to offering insurance coverage for pre-existing conditions.
• PED Waiting Period & Waiver Options: Most pre-existing disease Health insurance plans have a waiting period of up to 36 months. However, with the waiting period waiver add-on, you can reduce the waiting period from 2 to 1 year, as per the policy terms.
• Premiums Impacts: Premiums are generally higher in health insurance with pre-existing disease because the increased medical risk is taken into consideration by insurers.

Why Do Health Insurance Companies Avoid Covering Pre-Existing Diseases?

Health insurers are cautious with health cover for pre-existing conditions because PED in insurance comes with greater and more predictable healthcare risk. Understanding the PED meaning in health insurance helps buyers align expectations when selecting pre-existing disease health insurance

• High Initial Risk: Pre-existing diseases (PEDs) usually need continuous or costly treatment, making claims more likely in the early years of the policy.
• Adverse Selection: Without PED waiting period rules, insurance may attract mainly high-risk individuals, increasing insurers’ financial risk.
• Cost Control: Excluding or delaying PED coverage helps insurers keep premium costs manageable for all customers purchasing insurance for pre-existing diseases
• Facilitates Early Enrollment: It encourages people to buy health insurance early, before health issues arise, ensuring more comprehensive long-term protection.
• Risk Pool Management: Restricting PED in health insurance helps maintain a balanced and sustainable insurance pool in the interest of all policyholders.

Why Should You Choose Care Health Insurance for PED Coverage?

Selecting the right health insurance is essential, particularly if you have pre-existing diseases (PEDs). Care Health Insurance offers trustworthy, transparent plans that provide pre-existing disease coverage after a suitable waiting period, making it a strong choice for long-term insurance coverage.

With adaptable options and strong customer support, it guarantees you get the care you need without added stress. When considering health insurance for pre-existing conditions, Care Health Insurance stands out for the following reasons.

Plans include pre-existing illness health insurance, subject to a 3-year waiting period.

• Add-ons are available to reduce the PED waiting period.
• Transparent coverage and hassle-free claims make it the best health insurance for pre-existing conditions.
• Transparent PED clauses help avoid confusion during claim settlement.
• Cashless treatment for covered PED-related conditions at network hospitals.
• Efficient handling of PED-related claims with minimal paperwork.

How to Buy Health Insurance for Pre-Existing Disease Online?

Buying a mediclaim policy with us is quick, simple, and completely online. Just follow the following easy steps:

• Review the sum insured and available coverage options on the quote page, then click Buy Now.
• Fill in the proposer’s details and click Next to continue.
• Fill in the insured member’s details and share medical history, if required.
• Complete the payment to receive your policy documents immediately via email and SMS.

How to File a Claim Under Pre-Existing Disease Health Insurance?

Policyholders can raise a claim for pre-existing disease health insurance through two methods: cashless and reimbursement. Here’s how each process works: