Health insurance safeguards you against rising medical expenses, but if you already have a pre-existing disease (PED), your coverage may come with specific conditions. A pre-existing disease refers to any illness or medical condition that was diagnosed or treated before you bought the policy. In such cases, insurers often apply waiting periods or certain exclusions, which can affect your claim eligibility. Let’s understand how PED coverage works in health insurance in detail.
Pre Existing Disease Health Insurance : Overview
The Insurance Regulatory and Development Authority of India (IRDAI) defines pre-existing diseases (PED) as injuries, sickness, or any medical conditions that are diagnosed before buying a health insurance policy. Severe cases of injury are also considered as PED in some policies. This excludes if a policyholder is diagnosed with an illness within the first three months of purchasing a policy.
What is pre-existing disease in health insurance?
A pre-existing disease or PED is an illness or medical condition that the policyholder has before purchasing a health insurance policy. As per the Insurance Regulatory and Development Authority of India (IRDAI), if the insured was diagnosed with a disease or medical condition up to 48 months before buying the policy, it is termed as a pre-existing illness.
Some of the common examples of PED include all the long-term health issues such as high blood pressure, diabetes, thyroid, asthma, etc.
The healthcare costs of a pre-existing disease are typically higher, which is why some health insurers have exclusions or higher premiums for pre-existing conditions. Therefore, it is important to disclose all pre-existing conditions when purchasing health insurance to avoid any future claim rejections or complications.
What is the waiting period for pre-existing diseases in health insurance?
After purchasing a health insurance policy, people cannot file claims immediately. For this, they have to wait for a certain period during which they cannot claim benefits. The initial waiting period is the first 30 days after purchasing the insurance. It is usually common across all health plans. However, this may vary from policy to policy.
Insurers can get reimbursements for the treatment of their pre-existing conditions after the completion of the waiting period. Typically, this duration can be anywhere between 30 days to 2 years. However, this may vary among different providers and depends on the applicant’s age, policy, type of illness and other such factors.
Why do health insurance companies restrict coverage for pre-existing conditions?
Health insurance companies often limit immediate coverage for health insurance pre existing conditions to manage risk and keep premiums affordable for all policyholders. Covering pre-existing illnesses from day one could lead to a surge in claims, potentially destabilizing the insurer's finances and driving up premium costs for everyone, including those without such conditions. This risk management strategy ensures the sustainability of the insurance pool.
Why is it important to disclose pre-existing diseases to your insurer?
Transparency is key when purchasing health insurance. Failing to disclose health insurance pre existing conditions can lead to serious repercussions later. If the insurer discovers an undisclosed pre-existing condition during a claim, they have the right to reject the claim and even cancel your policy. Honest disclosure ensures that your policy remains valid, even with a waiting period for PED coverage, ultimately providing the financial security you sought and preventing claim denials when you need them most.
List of pre-existing diseases covered in health insurance in India
Pre-existing diseases are health conditions that individuals have prior to purchasing a health insurance policy.
Here is a list of pre existing disease in health insurance that are commonly considered
- High blood pressure
- Asthma
- Thyroid
- Diabetes
- COPD
- Arthritis
- idney disease
