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Pre Existing Disease Health Insurance

 

  • Comprehensive Coverage Including AYUSH Treatment
  • Tax savings upto 75000* under section 80D

Get ₹5 Lac Health Cover at ₹542/month^

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  • 24800+ Cashless Healthcare Providers^^
  • 48 LAKH+ Insurance Claims Settled**
  • 24*7 Claim and Customer Support

Your and your loved ones' health should be the top priority in an era that brought the pandemic and many more health-related catastrophes. Experiencing health issues due to poor lifestyle habits and family history is the last thing you would want to happen in your life. Thus, to overcome all the hurdles that hamper our health, you must know how vital health insurance is to stay in fine fettle  However, those with pre-existing diseases (PED) must know that one cannot get pre-existing diseases covered from day 1. 

Nevertheless, they can rest assured that they can get coverage under the best health insurance policy once the waiting period is over. We understand the need for coverage with pre-existing ailments; hence, we have an add-on to help you reduce the waiting period to 24 months from 48 months.

Read on to learn everything about pre-existing conditions.

What Does Pre-existing Illness Mean?

A pre-existing ailment is a condition that a policyholder has before getting a health insurance policy.  According to IRDAI, if you are diagnosed with a health condition 48 months before getting the health insurance policy, it is known as a pre-existing disease. Pre-existing diseases list include high blood pressure, high BP, asthma, thyroid, diabetes, etc.

What Does Waiting Period Mean?

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 takes place 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 4 main types of waiting periods fall under your health insurance plan. 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. Health insurance policies usually cover pre-existing diseases after having a policyholder serve a waiting period of 2 to 4 years, according to the plan. Therefore, hospitalisation and treatment expenses related to the declared pre-existing ailments can be claimed once the insured finishes waiting 2-4 years.
Waiting Periods for Named Ailments/Procedures: There are specific ailments & procedures, such as joint replacement, ENT disorders, cataract, etc., with the named ailments waiting period of at least two years.

Initial Waiting Period: All health insurance plans come with an initial waiting period, i.e., 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 end up making the mistake of not revealing pre-existing ailments while buying health insurance, and that is something no health insurance company encourages. You must know there is specific health insurance for pre-existing diseases, such as Care Freedom, that offer a waiting period of 2 years.You can purchase this plan in either an individual cover or a family floater cover 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.
  • It is possible to reduce the pre-existing waiting period by reducing the wait period add-on available under our different plans.

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 48 months, for pre-existing diseases. Before finalizing a health insurance option, select the one with a minimum waiting period.

Sum Insured: When there 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-ups: It is possible to get health coverage online for parents without pre-policy medical tests. However, in some cases, one may have to undergo a medical examination at the underwriter's discretion.

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 plan– Care Senior exclusively designed for senior citizens. This plan would help 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: A policy buyer may have to go for a pre-policy medical check-up at the underwriter's discretion.
  • Waiting Period: Health insurance plans with pre-existing disease coverage have a waiting period of 48 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.

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.

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

FAQ on Pre-Existing Conditions

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Q. How are pre-existing conditions determined?

Before the policy issuance, diseases, injuries, and other medical conditions are known as pre-existing conditions. Any physician diagnoses these 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 pre-existing disease claims is subject to policy terms and conditions.

Q. Could my health plan have the lowest waiting period for pre-existing diseases?

Your health plan can have the lowest waiting period for pre-existing diseases. However, you can choose a reduction in the waiting period add-on cover. The waiting period will be reduced from 48 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?

When buying health insurance, you must furnish complete details about your medical history, including any pre-existing disease. If you are 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 how much coverage one can get for a pre-existing ailment. However, there is a waiting period the policyholder must wait before getting the claim. Also, health insurance for pre-existing conditions can impact the cost of your premium. The premium will be higher for those with pre-existing ailments or medical conditions.

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 after that.

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 incurred during this waiting period will not be covered by your insurance provider. You can get coverage only after the waiting period is over.

^^Number of Cashless Healthcare Providers as of 31st March 2024

**Number of Claims Settled as of 31st March 2024

^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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