Things to Know About Health Insurance for Pre-existing Medical Conditions

There are numerous benefits of health insurance. It offers you financial protection in unexpected times and during medical emergencies, gives you peace of mind, provides you with an affordable solution to high medical costs and lastly, it ensures that you never compromise your health due to scarcity of funds. Just like the many benefits of health insurance, it also has certain terms and conditions. One of these is the coverage offered for pre-existing illnesses.

In today’s world, there are so many people who suffer from lifestyle diseases like thyroid, obesity, diabetes, hypertension and more. This is largely due to the increased stressors around us and indulging in substances like smoking, drugs and alcohol abuse that aggravate these diseases further.

Such factors can lead to chronic diseases like heart conditions, cancer, and asthma, posing a threat not just to our emotional stability but also to our financial well-being. There are so many expenses incurred for patients living with ailments that are terminal or life-long. These include the cost of medicines, regular tests and diagnostics, consultations etc.

A lot of people assume that health insurance does not cover pre-existing illnesses, but the truth cannot be farther from this. You can claim an insurance payout for such illnesses. However, that was not the case always.

It was not easy to claim health insurance for a person with a pre-existing disease (PED). There were certain terms and conditions in the old PED clause that restricted patients who had a pre-existing disease from availing of their health insurance. However, The Insurance Regulatory and Development Authority of India (IRDAI) has revised the pre-existing disease list as well as the pre-existing disease health insurance cover.

However, every health insurance in India has a unique clause for pre-existing ailments. Before you buy health insurance for your family, it is important to know a few details about how insurance companies compensate for these illnesses and what you must know about pre-existing disease health insurance.

Keep reading to know more.

According to the earlier definition, PED’s were classified as chronic diseases like high blood pressure, cancer, diabetes etc., that an individual possesses at the time of buying health insurance or whose symptoms develop three months after the date of issue. These diseases are thus, not covered under the insurance plan, and the policyholder cannot claim the insurance till the specified waiting period lapses.

For instance, if you are diagnosed with a disease as mentioned in the pre-existing disease list before buying the insurance, you won’t receive any coverage for medical expenses linked to that disease. Moreover, three months after buying the policy, if there are any imminent signs or symptoms that indicate the development of a fatal illness, that would also be considered a pre-existing disease.

In addition, if a disease needs to be treated as specified by a medical professional within 48 months from the date of insurance issued, that will also be categorized as a pre-existing disease. This has seriously impacted the rate of insurance buying in India.

As per the old clause, the pre-existing disease list in health insurance allowed the insurers to reject or terminate claim requests altogether if the policyholder had any of the diseases mentioned in that particular list. Insurance providers are generally apprehensive of giving a healthcare plan to people with chronic ailments as they have to undergo many procedures. This rejection of claims also led to people hiding their existing illness and not disclosing crucial information about their health when buying the health insurance initially. You should refrain from doing so, as, at the time of a health emergency, the insurer can reject your claim on the grounds of misrepresentation.

Now, the new definition has proved to be a game-changer. As per the circular from IRDAI on 10th February 2020, the Insurance Regulatory and Development Authority of India (IRDAI) has termed a pre-existing illness as a medical condition, sickness, disease, or injury, that has been diagnosed in the insured person prior to the purchase of a medical insurance plan. Any such medical condition diagnosed by a physician 48 months prior to the date of the issuance of the policy or its reinstatement is considered a pre-existing condition.

This move has changed the functionality of the pre-existing disease cover in health insurance completely. As a result, the rejection rate has been significantly brought down, which has aided people with a more positive attitude towards buying insurance.

According to the new terms, only those diseases that are prevalent and have been diagnosed before buying the insurance are considered PEDs. Therefore, if you have an illness that you were unaware of or was not diagnosed before the insurance came into effect, it would not be considered under PED.

This new amendment helps the policyholders in such a way that they won’t have to wait for a couple of years to claim their insurance for pre-existing diseases. The PED insurance would cover the costly treatments of such diseases.

Some of the most common pre-existing conditions include thyroid, high blood pressure, diabetes, asthma, cholesterol, etc. Most health insurance companies have a waiting period that can last from a couple of months to a few years before you start covering pre-existing illnesses. If you file a claim for such an illness during the waiting period, it would not be accepted.

1. The terms and conditions for health insurance for pre-existing conditions can differ

The screening process, waiting period, list of pre-existing illnesses, etc., can differ based on the health insurance policy, type of coverage, riders, insurance company, etc. Most insurance providers would request you to undergo a medical check-up, based on which you will be offered a policy. Some insurers may also consider your health history and age. Therefore, you must check the process of purchase and the terms and conditions before you select a medical insurance plan.

2. You should always disclose your pre-existing illness

Hiding details or providing misleading information to the insurance provider would only complicate things for you. In case of non-disclosure of a pre-existing condition, the insurance company reserves the right to reject your claim and also cancel your policy. This can be harrowing in times of urgency. Therefore, it is in your best interest to always be honest and share all crucial details of your health with the insurer at the time of purchase.

3. Pre-existing illnesses should be disclosed before you purchase a health insurance policy

A lot of people think that disclosing a pre-existing illness after they have purchased a medical insurance plan will fetch them a lower premium and help with saving more money. However, if you are found guilty of lying on your policy document purposely, the insurance provider can cancel your policy anytime.

4. Not all health plans cover pre-existing conditions

Not all health insurance plans cover pre existing conditions. Some plans may not offer you any protection against such ailments. Therefore, you must confirm with the insurance company at the time of purchase and select a plan accordingly.

5. There is a waiting period for pre-existing conditions

The basic understanding of the waiting period is that you cannot claim health insurance immediately after buying a healthcare policy. The policyholder must wait for a set time frame that ranges from 30 days to 4 years. The waiting period is the duration of time during which the insurance company will not compensate you for a claim related to your pre existing ailment. In such a case, you would have to bear the expenses out of your own pocket. The first 30 days after buying a healthcare plan is the initial waiting period, constant for all types of health insurance policies. You cannot avail of an insurance claim for any treatment in this initial waiting period. A medical insurance plan will cover pre-existing illnesses after the waiting period is over. The waiting period can vary from insurer to insurer and also depend on the type of illness, policy, age, and other similar factors. It can typically be between two years to four years.

6. You can waive off the waiting period in some cases

Some insurance companies offer the option to remove the waiting period clause on the receipt of some extra premium. Under this option, the duration of the waiting period is either reduced or the waiting period is entirely removed.

However, the insurance company will waive off the premium based on the severity of your illness. The insurance company may also not offer you this option if your condition is serious or you are at a relatively advanced age. So, it is best to confirm this before you go ahead and purchase health insurance.

7. The pre-existing illness can affect the premium of your health insurance policy

A pre existing condition can impact the premium of your medical insurance plan. If you have a pre-existing illness, you would have to pay a higher premium compared to applicants with no medical conditions. The precise premium amount would be decided on the basis of your illness, age, policy coverage, etc.

However, an important thing to keep in mind is that no matter the cost of the premium, you should never lie about your health history. You may save more by hiding information in the present but can incur extremely high costs at a later stage if your claim is rejected and you are forced to pay for your medical bills out of your own pocket.

8. The insurance provider can deny you a health insurance policy

The insurance company can deny you coverage against certain types of pre existing illnesses, such as cancer, diabetes, or if you have suffered heart attacks in the past. In some cases, you may get a health insurance plan, but certain illnesses may be excluded for the entire length of the policy.

Since the rules, terms, and conditions can differ for different health insurers, you must always compare several plans and pick a medical insurance plan that is suited to your unique needs, age, budget, and health conditions. Comparing different plans is easy thanks to the convenience of the internet.

Moreover, it ensures that not only do you end up with a plan that offers value for your money but you also stay protected against all types of medical costs when stuck in a medical emergency.

Tata AIG offers the MediCare line of health insurance plans for a comprehensive health cover for you and your loved ones. Our health insurance plans include a cover for pre-existing illnesses. However, the cover is activated after a waiting period of three years from the start of the policy tenure.

Health insurance is one of the most essential financial tools that you can consider purchasing for a financially secure future. It is affordable, flexible, and practical. It safeguards your savings and lets you live stress-free by protecting you and your loved ones. However, the credibility of your insurance plan largely depends on its coverage and features.

So, make sure to pick a plan that caters to your needs and covers various pre-existing illnesses so you never have to worry about money and can access the best of medical care in your hour of need.