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What is Pre-Existing Diseases (PED) Clause in Health Insurance?

Things You Should Know About Pre-Existing Diseases Clause in Health Insurance


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Living with chronic diseases like thyroid, hypertension, and diabetes is not a cakewalk. It has become an emotional, social, and even financial implication for the people. Earlier, it was difficult for individuals with pre-existing diseases to get health insurance. But, IRDAI has announced the new definition of PED that makes it easy for the people to buy health insurance that covers the treatment and hospitalization expenses related to their pre-existing diseases. So, let’s understand the new definition and other important aspects of pre-existing clause in health insurance.

How IRDAI defines Pre-Existing Diseases (PED)?

According to the new amendment of IRDAI, pre-existing diseases means any disease, illness or injury diagnosed by medical practitioner within 48 months, before the effective date of the policy issued. Diabetes, hypertension, COPD, cancer, epilepsy, depression, anxiety, allergies, and sleep apnea are some common pre-existing diseases.

Why it is 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 disclose all the information about your current medical conditions. You should show all your diagnosis to the team before you buy health insurance. In this way, you can get the claim timely, without the fear of rejection on the basis of false or misrepresentation of the medical history.

What is Waiting Period?

Before move on to pre-existing waiting period it is good to understand the concept of waiting period. You cannot claim under your health insurance policy right after its issuance. You have to wait for the completion of the time frame that may vary from 30 days to 4 years. It is called the waiting period.

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 within this time frame. 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 Waiting Period?

Pre-existing diseases like diabetes and hypertension have a long waiting period of 4 years. It means that you cannot file the claim for your hospitalization or treatment expenses under your health insurance cover during this time. Only after the completion of this span you can get the claim.

What is Specific Waiting Period?

Some specific ailments are covered under health insurance plan such as cataract, all types of hernia, internal tumours, kidney stone, Parkinson’s, etc. Expenses related to the treatment of these specific diseases are entitled for claim after the completion of 24 months waiting period. This time frame is considered as specific waiting period. How to Reduce PED Wait Period under Health Insurance Plan? You can opt for a reduction in the PED wait period as one of the add-ons to lessen the tenure from 48 months to 24 months.

Quick Facts about Pre-Existing 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 as pre-existing diseases under health insurance.
  • For health insurance portability you do not need to wait for the completion of the pre-existing waiting period.

We, at Care Health Insurance (Formerly Religare Health Insurance), make things easy for our customers with pre-existing diseases. You can opt for our cohesive health insurance product-Care Freedom that covers your pre-existing diseases like diabetes and hypertension. From cashless settlement to annual health check-up and only 2 years waiting period for pre-existing diseases, you can avail in one plan. So, opt it now and secure your health and future.

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