Pre-Existing Disease Health Insurance: Overview

Know why it is important to have a health insurance policy that covers pre-existing diseases.
Pre-existing disease cover in health insurance
3 mins

Health insurance policies in India have become popular due to the financial security that it provides during medical emergencies. However, we often tend to miss one important factor. It is the coverage of pre-existing diseases in health insurance policies. Given the changing lifestyle and habits, diseases like asthma, blood pressure, cholesterol, and diabetes have become very common. Hence, it is important to have pre-existing disease coverage in your health insurance policy.

Most regular health insurance policies do not cover these pre-existing diseases. This is because it increases the chances of claiming the policy for the treatment of such health conditions. However, health insurance companies have also evolved with time to cater to every individual’s health needs. Many health insurance policies now provide coverage even if the applicant has a pre-existing disease.
Read in detail about pre-existing disease cover in health insurance and the conditions applied to it.

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 diagnosed before buying a health insurance policy. Severe cases of injury are also considered PED in some policies. This definition excludes any diagnosis of illness within the first three months of purchasing a policy.

What is pre-existing disease in health insurance?

In health insurance, a pre-existing disease refers to any condition that a policyholder has been diagnosed with before purchasing the insurance. Generally, pre-existing diseases are covered after a waiting period specified by the health insurer. The waiting period may vary from six months to four years depending on the health insurance company. Pre-existing conditions are usually not covered in the initial waiting period; however, coverage starts once the waiting period is over.

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 a pre-existing illness?

Pre-existing diseases refer to medical conditions that intending policyholders are already suffering from while purchasing an insurance policy.

According to IRDAI, any disease or condition diagnosed up to 48 hours before purchasing the policy is a pre-existing illness. Pre-existing illnesses include long-term health issues, some of which are:

  • High blood pressure
  • Asthma
  • Thyroid
  • Diabetes
  • COPD

Important things to know about health insurance for pre-existing medical conditions

Here are a few things that you must be aware of about buying a health insurance policy that covers pre-existing diseases:

● Disclose any pre-existing medical condition

It is mandatory to disclose any pre-existing diseases that you may have at the time of buying a health insurance policy. In case of non-disclosure, the insurance company can rightfully reject your claim. Providing false or misleading information or hiding health details from the insurer will complicate matters at the time of raising claim requests. Eventually, burdening you financially at the time of a medical emergency.

● Insurance terms and conditions may differ for pre-existing illnesses

Most insurance companies ask for medical check-ups to screen pre-existing health issues before offering a health insurance policy. Some insurers may also consider the applicant’s age and medical history before providing pre-existing disease coverage. The screening process, the list of pre-existing conditions, and the waiting period will differ for different insurance companies and health plans. Therefore, it is advisable to check the terms and conditions before opting for a health insurance policy.

● Pre-existing illness can affect insurance premiums 

It is important to keep in mind that insurers charge higher premiums to people with pre-existing illnesses. The insurance company will determine the exact premium amount based on an applicant's age, illness, etc. However, applicants must be transparent about disease history regardless of the premium charges.

● Not all health plans cover pre-existing diseases

There may be some health plans that do not cover applicants against pre-existing ailments. Insurers may also not cover some pre-existing diseases for the entire policy tenure. Therefore, you must check with the insurance company about this and select a policy accordingly.

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 must 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.

Get reimbursements for the pre-existing conditions treatment after the completion of the waiting period. Typically, this duration can be anywhere between 30 days to two years. However, this may vary among different providers and depends on the applicant’s age, policy, type of illness and other such factors..

Tips to buy health insurance if you have a pre-existing disease

Here is a quick guide to help you find the right pre-existing disease cover health insurance policy that suits your requirement:

● Choose the right insurance provider

Although finding a health insurance policy that covers pre-existing diseases may be slightly challenging, there are many insurance companies whose rules are not stringent. Some providers consider a person's entire medical history for providing insurance and deciding premium rates.

However, some insurance companies only consider the applicant's last two months’ medical history. Applicants can opt for comprehensive health insurance policies from such insurers.

● Compare policies

Applicants must always compare plans of different providers before getting insurance for pre-existing illnesses. Also, carefully check the terms and conditions to pick a plan that best suits in terms of their age, budget, and other unique needs.

Finding an insurer that offers health insurance policies covering pre-existing diseases can be slightly challenging. However, digital insurance providers have made buying health insurance policies online hassle-free. Bajaj Finance Insurance Mall hosts a range of comprehensive health insurance policies offered by leading insurers in India. You can visit the website to check the policies and buy as per your requirement.

Frequently asked questions

What is PED in health insurance?

PED stands for pre-existing disease. It refers to any medical condition that the policyholder has been diagnosed with before purchasing the health insurance policy.

How are pre-existing conditions determined?

Health insurance companies usually look into the medical history of the policyholder, such as past and current illnesses, hospitalisations, surgeries, medication usage, etc. The insurance company may also request medical reports or physical examinations to determine the pre-existing conditions.

What are some examples of pre-existing health conditions?

Some examples of pre-existing conditions are diabetes, hypertension, cancer, asthma, chronic obstructive pulmonary disease (COPD), heart disease, etc.


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