Pre-existing Diseases in Health Insurance

Understanding Health Insurance Options for Pre-Existing Conditions

Many people don’t understand the importance of purchasing Health Insurance; they rely on their savings and employer-offered insurance. Is that enough to protect you and your loved ones?

We live in a fast-paced environment, where long work hours, unhealthy lifestyle habits and excessive stress make us prone to developing the disease at an early age. Our sedentary lifestyle leads to chronic diseases like heart conditions, cancer, and asthma. The rising medical inflation will drain our finances in medical emergencies. So it is wise to protect you and your family with a suitable health Insurance plan.

While purchasing health insurance, a common question arises in every mind: which health insurance cover pre existing conditions? Many people assume that Health Insurance doesn’t cover pre-existing illnesses, but it’s not true. However, the Insurance Regulatory and Development Authority of India (IRDAI) has revised the pre-existing disease list and coverage.

What is a pre-existing condition in health insurance?

Pre-existing disease in health insurance refers to illnesses or health issues that an individual has been diagnosed with, received treatment or medical consultation for, within a specified period before buying a health insurance policy. According to IRDAI, if the insured was diagnosed with a disease or medical condition up to 36 months before purchasing the policy, it is called a pre-existing disease.

It includes all long-term health issues like high blood pressure, thyroid issues, diabetes, asthma, etc. An insurer may impose waiting periods or exclusions for such conditions, negatively influencing claim eligibility. So let’s learn about existing illness cover in health insurance with a detailed view.

What is a Pre-existing Disease cover in a Health Insurance Policy?

As per the Insurance Regulatory and Development Authority of India (IRDAI), a pre-existing ailment is classified as a medical condition that has been diagnosed prior to buying a mediclaim plan. In simple terms, the insurer knows about the medical condition. Usually, the insurance company, in such a situation, asks insurers to serve a waiting period before getting the benefits of health insurance with pre-existing disease cover.

Moreover, insurance that covers pre-existing conditions in India has a different waiting period as compared to the base cover in the insurance plan. Also, it waiting period can differ from company to company- Usually, it ranges between 2-3 years.

Pre-existing disease waiting period

Most health insurance policies cover pre-existing diseases after a waiting period. During this period, the Insurer will reject any claim raised to treat an underlying disease.

The terms and conditions of the PED waiting period differ from plan to plan. Usually, its waiting period ranges from 12 months to 24 months to 36 months.

If you're wondering which health insurance covers pre-existing conditions with minimal delay, Star Health Insurance offers buy-back pre-existing disease (PED) cover as an optional cover, allowing policyholders to reduce the waiting period for pre-existing diseases in one of our products. This plan shines as one of the best medical insurance for pre-existing conditions across India. Under buy-back PED cover, policyholders can pay an additional premium to avail of coverage for medical conditions early without waiting for their policy’s waiting period to expire.

Why do Health Insurance Companies Dislike Pre-existing Diseases?

Insurers are apprehensive about providing coverage to people suffering from PEDs. You may wonder why?

You are more likely to file claims for your opted health insurance policy for pre-existing diseases, as compared to other people, if you have prior ailments. The insurer might have to take the burden of incurred medical expenses, as these individuals may require frequent medical attention. Therefore, it increases the liability of your insurers, as they avoid offering health insurance to people with pre-existing conditions. This is another prominent factor why you must buy medical insurance for your parents as early as possible.

Why is it important to Disclose Pre-existing Diseases to Your Insurer?

It is essential to be honest with your health insurer about pre-existing diseases while purchasing. While many people think that hiding existing illness can help secure a lower premium for an opt-in medical plan or easier approval however it can result in severe consequences.

In case your insurance provider discovers that you have not disclosed your prior illnesses, they have the right to reject your claim, especially if the treatment is associated with those undisclosed ailments. At the same time, insurance companies hesitate to issue health insurance for existing diseases that you may have. Considering the financial risk involved, service providers avoid covering pre-existing ailments.

However, to mitigate this risk, insurance providers may charge higher premiums, impose exclusions, or even reject the application for medical insurance.

How Do Pre-existing Diseases Affect Medical Insurance Policies?

The general medical insurance plans offered by the insurers provide financial assistance to individuals in case of unforeseen medical circumstances. The chances of raising a policy claim are 50-50 in that case. But with a health insurance policy for pre-existing diseases, the insurer and insurance company both know that the insured person will definitely raise a claim due to their medical illnesses. Therefore, it clauses can vary from one insurance company to another.

High premiums and waiting periods are the two decisive factors that affect your insurance policies with prior ailments. In addition, due to the existing condition premium for your policy will be high as the insurance company is taking a risk of covering the existing illness treatment. Therefore, the premium for your health insurance with pre-existing conditions will be decided based on the type of ailments you may have.

Things to Know Before Buying Health Insurance for Pre-Existing Diseases

Below are some of the important points to know while buying health insurance that covers pre-existing conditions in India:

• Pre-existing illness terms and conditions differ from policy to policy

The terms and conditions for covering pre-existing illness may vary from insurer to insurer. Getting a Health insurance with pre existing conditions may be challenging, but options are available to reduce the waiting period.
Many insurers may consider only the applicant's medical history for the past 36 months when determining a person’s pre-existing illness. Therefore, it is recommended that a person review the entire terms and conditions while purchasing plans, especially when they are planning to purchase plans for their parents. A health insurance policy that covers pre-existing diseases is much needed for older parents who are more susceptible to medical emergencies.

• Identify the Pre-existing disease

Minor health issues like cough, cold, and fever don’t fall under the pre-existing disease category. Not every ailment comes under this category. Insurers only consider a set of medical conditions and illnesses under this category that have long-term effects on a person’s health. Apart from this, existing illness cover meaning in health insurance, refers to a policy feature that provides financial protection for medical ailments diagnosed before the policy was purchased. 

• Never hide a Pre-existing disease from an insurer

Never hide a pre-existing medical condition you may have when taking a health insurance policy. Instead of this, individuals who may have had any prior ailments must go for medical insurance with pre-existing conditions coverage. Because if such information is hidden from the Insurer, the company can reject your claim if it concerns such a condition.
 

• Not all health plans cover pre-existing conditions
   

Yes, it is true that not all health plans provide pre-existing disease coverage. Some plans may not offer you any financial protection against such ailments. Therefore, you must confirm with your insurance provider while purchasing and select a plan accordingly.

• Choose a health insurance plan with a lower waiting period

Look for insurance with an antecedent health issue that offers a shorter waiting period. This ensures quicker access to benefits when you need them most. While checking the lower waiting period, an individual must review the PED list for the selected health insurance plan. It helps to secure financial assistance in case of a medical emergency. 

• Medical check-up

If you have a prior illness, the insurance company will ask you to go for a medical check-up. The insurance premium will be based on the reports. This is another reason why you must buy health insurance for parents with pre-existing diseases as soon as possible.

• Pre-existing Illness can affect the premium of your health insurance plan.

Health insurance covering pre-existing conditions can affect the premium of your selected plan. You would have to pay a higher premium compared to others with no medical issues. The precise premium amount would be calculated based on your illness, age, and plan coverage.

• Go for high sum insured

If you have an underlying condition and are seeking health insurance with existing conditions, then opting for high-sum insured plans is always better. Before opting for medical insurance, one should consider rising medical inflation and the high costs of surgeries.

• Check for the premiums

Before buying any health insurance plan, check the premium; the premium will be higher if you have any prior ailments that come under the list of PED in health insurance shown by your insurer while purchasing the plan.
 

• An insurance provider can deny you a health insurance policy
   

An insurance company can deny you coverage against certain types of ailments, such as cancer, diabetes, or if you have suffered a heart attack in the past. In some cases, you get coverage for named ailments in your health insurance, but certain illnesses may be excluded from the entire length of the policy.

Navigating Insurance With Pre Existing Conditions

Despite the challenges, getting health insurance with underlying medical issues is absolutely possible. So now the genuine question can be arise is that, which insurance company covers pre-existing diseases? In this context, Star Health offers coverage for pre-existing conditions with its special plan.

Many insurers now offer tailored plans that accommodate chronic illnesses, often with flexible waiting periods and optional riders. Some even provide disease-specific coverage for conditions like diabetes or cardiac issues.

When choosing a plan:

• Read the fine print
• Ask about disease-specific riders
• Consider portability options if switching insurers
• Look for lifetime renewability
   

You can still get a mediclaim policy if you have pre-existing health problems. Just check the waiting period and coverage terms under your chosen policy. Star Health Insurance’s Buy-back PED benefit is a great example of how insurers are evolving to meet the needs of individuals with chronic conditions.

What pre-existing conditions are not covered?

A very common question that can arise in anyone’s mind that what pre-existing conditions are not covered? While many service providers are providing health insurance with pre-existing disease cover, however, multiple conditions may be excluded, such as plastic surgery, which is not medically necessary, including Botox or implants. In addition, self-inflicted injuries, which are intentional self-harm, are also excluded. Cosmetic and elective treatments like certain weight loss procedures, are generally not covered. Moreover, injuries from alcohol abuse, including damage to the liver caused by overconsumption of alcohol, may not be covered. This is why it is recommended that, while purchasing medical insurance for pre-existing conditions, an individual must disclose everything honestly to their insurers, including medical history or prior ailments. Before purchasing, it is advised to carefully read the policy to understand any specific exclusions for your conditions.

Conclusion

In today’s world, insurance with pre-existing conditions isn’t just a possibility—it’s a necessity. With the right plan, you can secure peace of mind, financial protection, and access to quality healthcare when it matters most. In this way, Star Health provides one of the best health insurance for pre-existing diseases with specialised plans.

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