Medical Insurance and the Curious Case of Pre-Existing Health Conditions

You may have heard about nightmare situations of claims rejection when an insured person wanted payment or reimbursement for treating a pre-existing illness. Why and when does this happen? Understanding this matter clearly before buying a health plan and avoiding such a situation is essential.

A pre-existing condition for health insurance is an illness or a disease that a person already has before purchasing a health insurance policy. According to the Insurance Regulatory and Development Authority of India or IRDAI, if the insured has a disease or illness 48 months before buying the policy, it is considered a pre-existing health condition. Chronic health issues like hypertension, diabetes, asthma, and thyroid are all considered to be pre-existing health conditions. Simply put, the insured showed symptoms or was diagnosed with a health issue before the health insurance policy's effective date.

What is Health Insurance for Pre-Existing Conditions?

Most health insurance policies in India cover pre-existing health conditions after a waiting period. However, it will be rejected if any claims are made to treat the health issue before the waiting period is over. Typically, the waiting period for a pre-existing condition for health insurance ranges from 2 to 4 years.

List of Pre-Existing Disease Covers in Health Insurance in India?

The table below shows a list of medical insurance for pre-existing conditions in India:

Factors to Consider When Buying Health Insurance for Pre-Existing Diseases

When buying medical insurance for pre-existing conditions, a few factors must be considered. These include:

• Waiting period: Most health insurance companies have a waiting period before covering pre-existing conditions, which usually ranges from 2 to 4 years. Choose plans with the shortest waiting period.
• Policy premium: As the risk associated with pre-existing health conditions is higher, you might have to pay a higher premium.
• Coverage and benefits: Opt for comprehensive insurance plans that cover outpatient consultations, hospitalisation expenses, and even diagnostic tests.

Effects of Pre-Existing Disease on Your Health Insurance

Pre-existing diseases affect coverage options and costs, resulting in higher premiums, specific treatment exclusions, and a waiting period. If you have a pre-existing disease, you might face stricter criteria regarding health insurance, limiting coverage benefits. In some cases, insurance providers deny coverage.

Pre-Existing Disease Waiting Time

A waiting period is the time after which pre-existing diseases are covered under the health insurance policy. Usually, the waiting period for medical insurance for pre-existing conditions is between 2 and 4 years. If a claim is raised before the waiting period or cooling period is over, it can be rejected. If the claim is raised after the waiting period has passed, the insurance provider cannot deny it.

Types of Waiting Periods Under Health Insurance Plans

Some of the kinds of waiting periods are:

• Pre-existing disease waiting period: Pre-existing health conditions have a waiting period if the insured has health issues like diabetes, hypertension, asthma, and thyroid, to name a few. Most health insurance policies cover pre-existing conditions after the passage of a waiting period.
• Waiting period for a specific ailment: In some cases, the health insurance policy might have a waiting period for ailments and processes like ENT conditions, hernia, cataract surgery, joint replacement surgery, and osteoporosis. Any medical expenses resulting from these ailments will only be covered after the waiting period, usually 1 to 2 years.
• Initial waiting period: Most health insurance plans have an initial waiting period of 30 days from the effective date, during which no claims are accepted.
• Critical illness waiting period: Regular health insurance policies usually cover critical illnesses after a 90-day waiting period.
• Maternity benefit waiting period: Some health insurance plans only cover maternity benefits and cover newborn babies after a waiting period of 9 to 36 months is over.

Dos and Don'ts in Case of Pre-Existing Diseases

If you are getting medical insurance for pre-existing conditions, there are a few critical rules that you should follow.

What Should You Do When Buying Pre-Existing Disease Health Insurance?

If you have a pre-existing health condition and you want to buy a health insurance, consider following these steps:

• Be transparent: One of the most important things is to be transparent about your medical history and any pre-existing conditions. When you disclose this information, you avoid the chances of the claim getting rejected.
• Select a plan with a lower waiting period: The waiting period for medical insurance for pre-existing conditions depends on one provider to the other, as well as the severity of the disease. After comparing plans from different providers, select a plan with a lower waiting period.

Pre-Existing Conditions and Health Insurance: Plans You Can Consider

When selecting a health insurance policy with a pre-existing condition, it is essential to check the premium payable and the policy's waiting period. Health Insurance strives to provide you with the best services and facilities. Check out the three policies offered:

ManipalCigna Sarvah Pratham and Uttam

The usual waiting period for a pre-existing health issue is 36 months. The Sarathi optional cover states that any hospitalisation caused by cancer, stroke, heart issue, or major organ or bone marrow transplant arising from any pre-existing disease will be covered only after the first 30 days from the policy inception; the standard 36-month PED waiting period will not be applied. Pre-existing diseases include asthma, diabetes, obesity, hypertension, and dyslipidaemia.

Note: This optional cover is available only during the First Policy Year and not during renewal.

ManipalCigna Sarvah Param

This policy does not have a waiting period for a pre-existing health issue. ManipalCigna health insurance offers a plan with minimum waiting periods for pre-existing health conditions, at 36 months. If you need health insurance, consider buying it from ManipalCigna.

Conclusion

Before selecting a health insurance plan, every policy buyer must disclose information about their and their family's medical history, including any pre-existing health condition. This transparency makes it easier to make claims successfully. Concealing this information can cause the claim to be rejected, causing financial strain in case of any emergencies.

Secure your Future Today with ManipalCigna Health Insurance

Ensure comprehensive coverage for your medical needs with ManipalCigna's tailored insurance plans. Explore options that offer transparent terms and manageable waiting periods for pre-existing conditions. Begin your path to secure and reliable health coverage today.

FAQs

How are pre-existing conditions determined?

If the insured was diagnosed with any health ailments 48 months before purchasing an insurance policy, that is termed a pre-existing condition.

Does a pre-existing illness have any impact on the amount of coverage?

Any pre-existing health issue will impact the coverage amount and the premium payable.

What are pre-existing diseases (PED) in health insurance?

A pre-existing health condition is a long-term illness diagnosed at least 48 months before purchasing health insurance. This includes cancer, diabetes, heart issues, hypertension, and even asthma.

What is the waiting period for pre-existing disease in health insurance?

The waiting period for any pre-existing condition depends on the severity of the ailment and the insurance provider. It usually ranges from 1 year to 4 years.

Can I be denied health insurance because of a pre-existing condition in India?

When buying health insurance in India, you must disclose all pre-existing health conditions you have. If there is non-disclosure of an ailment, and you wish to make a claim, the health insurance company has the right to deny the insurance claim.

What is a pre-existing disease before 48 months?

Regarding health insurance, if you have been diagnosed with a health condition 48 months or more before purchasing a policy, that health condition is deemed a pre-existing disease.

What is a severe pre-existing condition?

Health conditions like diabetes, asthma, and high blood pressure are pre-existing severe health issues.