How Does Pre-Existing Disease Coverage Actually Work?

Guide to Health Insurance for Pre-Existing Conditions

According to the Insurance Regulatory and Development Authority of India (IRDAI), a pre-existing disease refers to a medical condition that you already have before purchasing a policy.

Since the insurer is already aware of the condition, coverage for such illnesses usually comes with a waiting period. This specific period is separate from the policy’s basic waiting period and may vary across insurers. In most cases, it ranges between 1 and 3 years.

How Do Insurance Providers Get to Know About Pre-Existing Medical Conditions?

When you fill out the form for buying a medical insurance policy, you need to mention the illnesses you are living with or any treatment you have undergone during your lifetime. After that, your insurer sends all the details to their board of medical experts to differentiate between newly contracted and pre-existing illnesses.

What is the Waiting Period for Pre-Existing Diseases in Health Insurance?

Most health insurance policies come with a waiting period of 12 to 36 months for pre-existing diseases. However, this period can vary from one plan or insurer to another. If you raise a claim during this waiting period, the insurer has the right to reject it.

Why Should You Disclose Pre-Existing Diseases to Your Insurer?

You should disclose your existing illness to your insurer to avoid severe consequences. They have the right to reject your claim, particularly when the medical condition has a connection to those undisclosed ailments. At the same time, insurers may be cautious about issuing new health insurance to cover existing medical conditions.

What Factors Should Be Considered While Buying Health Insurance that Covers Pre-Existing Diseases?

First of all, you need to go through the policy brochure line by line, since pre-existing illness terms and conditions vary widely from policy to policy. Then, you must have a proper understanding of pre-existing diseases. Cough, cold, and fever don't fall under this category. And lastly, choose a plan with a shorter waiting period.

Which Pre-Existing Conditions Does Medical Insurance Not Cover?

In general, medical insurance does not cover non-essential medical procedures such as cosmetic or plastic surgery, Botox, or implants. Also, injuries, which are intentional, weight loss treatments, and illnesses due to excessive alcohol consumption, such as liver diseases, are generally not covered under health insurance.

Does Health Insurance Consider High Blood Pressure a Pre-Existing Condition?

Yes, high blood pressure or hypertension is one of the common pre-existing diseases. To know what diseases your health insurance plan covers, you must review the list of pre-existing diseases applicable to your policy. It helps ensure you have financial support if a medical emergency arises.

Can I Reduce the Waiting Period for Pre-Existing Diseases in My Health Insurance Plan?

There are certain medical insurance policies that provide the facility of riders to reduce the waiting period for pre-existing diseases. However, policyholders usually need to pay an additional premium to avail of this benefit.

What is a Pre-Existing Disease Covered From Day 1?

Some insurance companies now design policies that cover pre-existing conditions from day 1. Since such conditions have a higher chance of claiming coverage, insurers may charge a higher premium or often provide limited coverage.

What Does Pre-Existing Disease Coverage 36 Months Mean?

Pre-existing disease coverage 36 months refers to any illness, injury, or medical condition that doctors detected within 36 months before buying a health insurance policy or for which medical advice or treatment was received during that period.