Health Insurance for Pre-Existing Conditions

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: Does the policy cover pre-existing diseases? 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?

A pre-existing condition or illness is a medical condition that the insured has before buying a health insurance policy. According to IRDAI, if the insured was diagnosed with a disease or medical condition up to 48 months before purchasing the policy, it is called a pre-existing disease.

Pre-existing diseases include all long-term health issues like high blood pressure, thyroid, diabetes, asthma etc.

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 a pre-existing condition.

The terms and conditions of the pre-existing condition waiting period differ from plan to plan. Usually, a pre-existing disease waiting period ranges from 12 months to 24 months to 48 months.

However, 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. 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.

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

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 policy that covers 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 48 months when determining a person’s pre-existing illness.

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 is a pre-existing disease. Insurers only consider medical conditions and illnesses that have long-term effects on a person’s health as Pre-existing diseases.

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. If such information is hidden from the Insurer, the company can reject your claim if it concerns such a condition.

Choose a health insurance plan with a lower waiting period

When you buy an individual or family health insurance plan, a pre-existing waiting period permanently restricts you from filing a claim for a specific period.

The insurance company will reject any claim raised for such diseases during the waiting period. The time duration of the waiting period differs from policy to policy.

So, one should opt for a health insurance policy with a lower pre-existing disease waiting period.

Medical check-up

If you have a pre-existing disease, the insurance company will ask you to go for a medical check-up. The insurance premium will be based on the reports.

Go for high sum insured

If you have a pre-existing disease, opting for high-sum insured plans is always better. Before selecting a health insurance plan, 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 due to pre-existing diseases.
So, getting health insurance at a younger age is always advisable, as the risk of pre-existing disease is low.

You can still get a health insurance plan if you have a pre-existing health illness. Just check the waiting period for pre-existing diseases under your chosen health policy. Also, note that Buy-back PED benefit is offered only by Star Health Insurance as an optional cover allowing policyholders with pre-existing medical conditions to purchase additional coverage for health conditions.

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FAQ

What pre-existing disease is covered by health insurance?

The most common pre-existing diseases include thyroid, high blood pressure, cholesterol, and asthma. Most health insurance companies have a specified waiting period to cover these conditions, which may vary from 12 months to 24 months or 48 months

Should I have to declare a pre-existing disease?

Yes, you must declare a pre-existing disease to the Insurer before buying a health insurance policy. It is unwise to hide any such information, which may lead to the rejection of insurance claims during treatment.

Is high blood pressure a pre-existing disease?

Yes, hypertension (high blood pressure) is one of the most common pre-existing conditions.

How many times can one claim health insurance?

You can claim any number of times in your health insurance policy until your sum insured is not exhausted.