Are Pre-existing Diseases Covered in Health Insurance Plan

Many people end up not taking health insurance because they suffer from ailments like diabetes, cardiac issues, or even high BP. They feel that health insurance companies do not cover pre-existing diseases, and hence it would be a waste of money for them. It can surprise you because many health insurance companies have started covering pre-existing conditions.   

Health insurance is a competitive sector, with many players vying to provide the best services to customers. International insurance behemoths have also jumped into the fray. Under such circumstances, health insurance companies have changed their approach towards customers by offering insurance cover on pre-existing ailments, as well. While the cover provided for such persons is at par with normal individuals, the premium is a bit on the higher end.

What is a Pre-Existing Disease?

You should be clear about the pre-existing diseases concept. The following conditions constitute pre-existing ailments. (Source – IRDAI)

• Any medical condition, ailment, disease, or injury that is/are diagnosed by a doctor within 48 months before the effective issuance date of the policy.

• Any condition for which treatment was recommended by, or received from a doctor within four years before the effective policy issuance date

In September 2019, IRDAI had modified the definition of pre-existing diseases to include specific illnesses if diagnosed within the first three months after the issuance of the health insurance policy. 

However, IRDAI on its website has clarified on February 10, 2020, that this modification dated September 27, 2019, stands deleted until further notice. 

Insurance companies can introduce a waiting period during which the disease will not be covered. The waiting period could be anything from two to four years, depending on the condition, and the 
insurance company’s rules.

Thus, insurance policyholders have reasons to rejoice because it reduces claim rejection rates. 

What Diseases Qualify As Pre-Existing Diseases?

Generally, diseases that require continuous treatment or those having a chance to occur again qualify as pre-existing devices, subject to the conditions mentioned above.

• Pre-existing diseases or medical conditions include high blood pressure, diabetes, cancer, asthma, heart ailments, depression, epilepsy, lupus, etc. The list is exhaustive.

• It does not include your common cold, flu, and other regular ailments affecting people.  

• The chickenpox that you had during your childhood does not constitute a pre-existing disease. Still, if you have a congenital heart ailment, it qualifies as a pre-existing condition, even if you are not undergoing any treatment for it at present.

What To Do When You Have A Pre-Existing Ailment?

The insurer will not know that you have a pre-existing condition unless you inform them at the time of applying for health insurance. It is your responsibility to declare a pre-existing illness. If you conceal this critical information from the insurance company, they have the right to reject your claim in the future if it is discovered that you deliberately withheld such information from them.

You should arrange to get the health checks done before the issuance of the policy. You should also go through the entire list of pre-existing ailments (different insurance companies have different plans) before signing on the dotted line.

Nowadays, many health insurance providers issue health insurance policies without any medical check-up. Hence, it becomes critical for you to declare your pre-existing ailments to avoid disappointments later on.

Conclusion

With the medical costs increasing day-by-day, every individual must have adequate health insurance. Having any pre-existing ailment does not disqualify you from applying for a health insurance policy. Read the conditions properly and go ahead with applying for your health insurance and live a stress-free life.

Disclaimer: This article is issued in the general public interest and meant for general information purposes only. Readers are advised not to rely on the contents of the article as conclusive in nature and should research further or consult an expert in this regard.