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Pre Existing Disease Health Insurance

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  • Comprehensive Coverage Including AYUSH Treatment
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Insurance Claim Settlement Ratio

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    Pre-Existing Disease Cover in Health Insurance

    Good health is a plant that needs to be well-nurtured to lead a healthy life. We often have to face risk due to various factors- right from lifestyle to family history – giving rise to ailments. To ensure that we overcome all the hurdles that hamper our health, we all need to know how vital health insurance is to stay hale and hearty. Problems are unforeseen events like a planned surgery or emergency hospitalization. However, those with pre-existing diseases (PED) need to be aware of the crucial fact that one cannot get coverage under health insurance for pre-existing conditions right from day one.

    Nevertheless, they can be rest assured that they can get coverage under the best health insurance policy once the waiting period is over. CHI understands the need for coverage with pre-existing aliment, and the waiting period can be reduced with our Add-on option that reduces your waiting period to 24 months from 48 months.

    Let’s learn about pre-existing disease in health insurance and its nitty-gritty.

    What do Pre-existing Health Condition Mean?

    Pre-existing health conditions are basically health problems that the policyholder faces 48 months before the commencement of the healthcare policy.

    Understanding pre-existing disease cover is essential for those who already have an existing illness and are looking to buy health insurance.

    IRDAI Announcements on Pre Existing Disease Health Insurance

    According to an update issued in February 2020, the protocols for "health insurance pre-existing conditions" were amended.

    Read about health insurance pre-existing conditions, the new amendment by IRDAI, and how it is beneficial for policyholders having a pre-existing disease.

    According to the new amendment, no disease or illness shall be considered a pre-existing disease if diagnosed within three months from the date of buying the policy. IRDAI has taken a thoughtful decision that will help reduce their pre-existing disease waiting period.

    Note: However, the amendment in health insurance pre-existing conditions is not applicable to travel insurance.

    Health Insurance Pre-Existing Conditions Old vs New

    Below is the difference between the old and the new definition of pre-existing diseases:

    Old Definition of Pre-Existing Diseases

    New Definition of Pre-Existing Diseases

    That was diagnosed by any physician within 48 months, before the effective date of the policy issuance.

    That was diagnosed by any physician within 48 months, before the effective date of the policy issuance.

    Any medical condition for which medical advice or treatment was received from any physician within a 48-month duration before the policy’s effective date or its reinstatement.

    Any medical condition for which medical advice or treatment was received from any physician within a 48-month duration before the policy’s effective date or its reinstatement.

    Any condition for which symptoms/ signs if presented and have resulted within three months of the policy issuance in a diagnostic illness or medical condition.

    According to the amendment, this clause has been deleted.

    Disclaimer- Underwriting of Pre-existing condition claims is subject to the terms and conditions of the policy.

    How are the IRDAI Guidelines on Health Insurance Pre-Existing Conditions Beneficial for Policyholders?

    The IRDAI guidelines will benefit a policyholder in the following ways:

    • It will significantly reduce the claim rejection rates 
    • It takes away most of the ambiguities in pre-existing diseases
    • The instances of the insured not disclosing the true medical history will reduce, and they will get claims without facing claim rejection

    Health insurance has now become a necessity. Earlier, it was difficult for people with pre-existing conditions to get complete coverage as there were chances of claim rejection or an increase in the waiting period. The IRDAI guidelines are beneficial for people who could not afford the treatment of their pre-existing disease and had to face claim rejection. After the amendment, even if they are diagnosed with such chronic diseases after buying a policy, they will get a claim, subject to policy terms and conditions.

    Why is it necessary to disclose PED while buying a health insurance policy?

    Many people do not disclose their health issues and even hide the history of pre-existing diseases. However, it is advisable to reveal all the information about your current medical conditions. Show all your related diagnoses to the team before you buy health insurance. In this way, you can get the claim timely, without the fear of rejection based on false or misrepresentation of the medical history.

    Care Health Insurance offers cashless health insurance plans to people with pre-existing diseases so that they can avail the best possible treatment without worrying about arranging money to pay the hospital bills. Policyholders can file a claim after completing the stipulated waiting period for pre-existing diseases as per the plan. Let's understand the waiting period in more detail.

    What is Waiting Period?

    A waiting period is a pre-specified duration during which you cannot claim under your health insurance policy right after its issuance. You have to wait to complete the time frame that may vary from 30 days to 48 months based on the plan.

    What is Initial Waiting Period?

    There is an initial waiting period of 30 days in every health insurance policy. It means you cannot file a claim for the expenses related to the treatment of any disease in this duration. Your policy coverage starts after the completion of this tenure. It does not recur every year. It is only for the first time when you buy the policy. However, this condition is not applicable in case of an accident.

    What is the Pre-Existing Disease Waiting Period?

    Pre-existing diseases like diabetes and hypertension have a long waiting period of 48 months. It means that you cannot file the claim for your hospitalization or treatment expenses under your health insurance during this time. After the completion of this span, you become eligible for claim settlement. However, we offer a reduction in wait-period add-on that you can opt for along with your base policy. This add-on helps you to reduce the pre-existing waiting period from 48 months to 24 months as per the plan.

    What is Specific Waiting Period?

    Some specific ailments such as cataract, all types of hernia, internal tumours, kidney stone, Parkinson's, etc., are also covered under a health insurance plan. You can get coverage for the treatment expenses related to these specific diseases after the completion of 24 months waiting period. This time frame is the specific waiting period for named ailments.

    Quick Facts about Pre-Existing Disease Waiting Period

    • The terms and conditions related to pre-existing diseases may differ from plan to plan.
    • There are only specific diseases that are considered pre-existing diseases under health insurance.
    • For health insurance portability, you do not need to wait to complete the pre-existing waiting period.
    • It is possible to reduce the pre-existing waiting period with a reduction in the wait period add-on available under our different plans.

    How do I 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 cover.

    Waiting Period: In India, it is impossible to find health insurance for pre-existing conditions with no waiting period. Any medical insurance option you choose for your parents will have a waiting period, usually 48 months, for pre-existing diseases. Before finalizing a health insurance option, ensure that you have selected the one with a minimum waiting period.

    Sum Insured: When is a chance of emergency hospitalization 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-up: It is possible to get a health cover online for parents without pre-policy medical tests. However, in some cases, one may have to go through a medical examination at the underwriter's discretion.

    Affordable Premium: It is more likely that the 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 careful comparison and review of various plans.

    Things to Remember if you Have a Pre-Existing Medical Condition

    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. There is a list of pre-existing conditions 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: In some cases, a policy buyer may have to go for a pre-policy medical check-up, as per the underwriter's discretion.
    • Waiting Period: Health insurance plans with pre-existing disease cover have a waiting period of 48 months. However, you can also opt for a reduction in the waiting period for pre-existing diseases as an add-on benefit offered by us at an additional premium.
    • Premium: The health insurance premium, due to pre-existing disease, will be on the higher side. It is so because we are taking the risk of covering a pre-existing illness.

    *Health insurance premium, due to pre-existing disease, will be on the higher side. It is so because we are taking the risk of covering a pre-existing illness.

    It is in your best interest if you 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 availing of health insurance or a mediclaim for pre-existing diseases, Care Health Insurance could be your best take catering to all your needs.

    Disclaimer: The above information is for reference purposes only.

    FAQ on Pre-Existing Conditions

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    Q.How are pre-existing conditions determined?

    The diseases, injury, and other medical conditions that existed before the policy issuance are known as pre-existing conditions. These are diagnosed by any physician within 48 months, before the effective date of the policy issuance.

    Q.Can I be denied health insurance if I have a pre-existing condition?

    You can get a policy even if you have a pre-existing medical condition. However, underwriting of claims for pre-existing diseases is subject to policy terms and conditions. 

    Q.Could my health plan has a pre-existing condition waiting period?

    Yes, your health plan has a pre-existing condition waiting period. However, you can choose a reduction in the waiting period add-on cover. The waiting period will be reduced from 48 months to 24 months , subject to policy terms and conditions.

    Q.What if I am aware of a pre-existing ailment and do not disclose it? 

    It is of utmost importance to furnish complete details about your medical history, including any Pre-existing disease, when buying health insurance. If you were aware of your Pre-existing ailment but do not disclose it to the insurer, you will most likely face a claim rejection if you get hospitalized for treating the condition. It is so because there is a waiting period applicable for Pre-existing ailments, and the policyholder cannot get a claim during this period.

    Q.Does a pre-existing illness have any impact on the amount of coverage? 

    There is no impact on the amount of coverage one can get for a pre-existing ailment. However, there is a waiting period the policyholder must wait before getting the claim. Also, a pre-existing disease in health insurance is a factor that will impact the cost of your premium. The premium will be higher for those who have a pre-existing ailment or a medical condition.

    Q.What are pre-existing diseases (PED) in health insurance?

    It means any health condition, ailment, injury, or related condition for which signs or symptoms were diagnosed. Medical advice or treatment was received within 48 months before the first policy issued by the insurer and renewed continuously thereafter.

    Q.How are Pre-existing Diseases covered in Health Insurance?

    As per the rules and regulations, any hospitalisation or medical bill related to your pre-existing disease that is incurred during this waiting period, will not be covered by your insurance provider. You will be able to get coverage only after the waiting period is over.

    Q.Why is disclosing pre-existing illnesses necessary?

    You should always disclose your pre-existing conditions and other details about yourself to your insurer to ensure that your claim doesn’t get rejected.

    Q.What is pre-existing condition waiver?

    It is an advantage cover for PEDs which waves of the exclusions and covers the cost related to hospitalization due to Pre-existing conditions.

     

    ^^Number of Cashless Healthcare Providers till 25th March 2022.

    ^Annual premium for product 'Care' and 'Care Shield (add on)' is Rs. 6160/-(excl. GST) for 1 adult falling under the age bracket 05-24 years, 1 Adult 18-24 age group 3 Yr with NCB Super (Add-on).

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