In today’s hectic lifestyle, where people are more prone to diseases and chronic illness, having health insurance by your side is just the right choice. The most important factor to keep in mind is to know about the Pre-Existing Condition in health insurance, and how it affects the health insurance coverage plans. 

Let us understand what is a Pre-Existing Condition and how it affects your coverage plan

What is a Pre-Existing Condition?

According to the Insurance Regulatory and Development Authority of India (IRDAI), pre-existing illnesses are classified as medical conditions diagnosed before purchasing a health insurance plan. In adherence to the IRDAI, an individual is diagnosed with a disease or medical condition up to 48 months before buying the health cover, referred to as a preexisting condition. 

The preexisting condition could be any health issue ranging from chronic illness, heart disease, mental health disorders, or even injuries that took place in the past 

Also Read : 5 Factors to Consider While Getting Health Insurance

Waiting period for Pre-Existing Condition

Most insurance companies today do have a specified waiting period for the pre-existing condition of an individual. During this waiting period, the policyholder cannot raise a claim with the insurance provider for the treatment of any pre-existing condition. In a health insurance policy, the waiting period for a Pre-Existing Condition could range from two to four years, depending on different insurance providers. However, it is always suggested to shift to a different insurance provider only after the completion of your waiting period. Nevertheless, the insurance companies also offer to reduce the waiting period but in that case, the policyholder will have to pay an extra premium amount.  

What are Some Examples of Pre-Existing Health Conditions? 

The pre-existing condition in health insurance covers a broad array of health issues and conditions. Some common examples of pre-existing conditions may include:  

  • Cancer  - A history of cancer also comes under pre-existing conditions. 
  • Heart conditions  It may include heart disease or a history of heart attacks. 
  • Chronic diseases  - These include high blood pressure, thyroid, diabetes, hypertension, or asthma. 
  • Autoimmune diseases  - For conditions like lupus and rheumatoid arthritis.
  • Pregnancy  - In most health insurance policies, pregnancy is considered a pre-existing condition, if an individual is pregnant before the commencement of the policy. 

Also Read: Difference Between Health insurance and mediclaim

Let us explain with scenarios

Case 1: Chronic Illness

Scenario:

Ram has been managing diabetes for the past five years with medication and regular check-ups. When John applies for a new health insurance policy, he discloses his diabetes to the insurer.

Outcome:

The insurer acknowledges Ram's diabetes as a pre-existing condition. As a result, there might be a waiting period before his diabetes-related treatments are covered. However, once this waiting period is over, Ram's treatments and medication for diabetes are covered by his insurance.

Case 2: Past Surgery

Scenario: Meena underwent knee surgery two years ago due to a sports injury. She has recovered well but occasionally needs physiotherapy.

Outcome:

Meena’s knee surgery and any related complications or treatments, such as physiotherapy considered pre-existing conditions. When Meena buys a new health insurance policy, she discloses her surgery. The insurer might impose a waiting period or exclude coverage for treatments related to her knee for a specific period. Once the waiting period ends, her policy will cover related treatments.

Case 3: Hypertension

Scenario:

Raj has been living with hypertension for over a decade, which he controls with medication and lifestyle changes. He applies for a new health insurance policy and discloses his condition.

Outcome:

The insurer recognizes hypertension as a pre-existing condition. There may be a waiting period for claims related to hypertension. After this period, Raj's insurance will cover his hypertension management, including doctor visits, medication, and any complications arising from it.

Two Quick Tips to Find the Best Health Insurance Policy with a Pre-Existing Condition

For an individual having a Pre-Existing Condition, it is important to keep a few things in mind to get a suitable health insurance policy for him/her. Here are 2 tips to consider while opting for health coverage with a Pre-Existing Condition: 

Never hide a Pre-Existing Condition

Be transparent with your insurance company and the insurer about Pre-Existing Conditions at the time of buying health insurance to avoid claim rejections.

Choose a Health Plan with a Less Pre-Existing Condition Waiting Period 

As the insurance companies have a specified waiting period for a pre-existing condition during which the policyholder cannot file any claim. Make sure you opt for health insurance coverage that has a lower waiting period for your pre-existing condition. 

Bottom Line!

Health insurance coverage is important and is for every individual, though any preexisting condition could affect the terms and conditions of the insurance policy. Having a preexisting condition is bound to affect the premium, waiting period, or the claim settlement process such that you need to carefully research the available health insurance options in the market and opt for the one that best suits you. However, insurance companies also have some concerns about the financial implications of the preexisting condition of an individual, so it is important to be transparent with your insurer and avail yourself of secured health insurance coverage. 

Frequently Asked Questions on Pre-existing Conditions

Q - How are pre-existing conditions determined?

A - Pre-existing conditions are determined based on any detected health issue or illness that an individual already had before the commencement of the health insurance policy. 

Q - Can I be denied health insurance if I have a pre-existing condition?

A - An individual is not denied health insurance on having a preexisting condition, but yes a pre-existing condition may affect the terms and conditions of the health coverage, which also vary among different insurers. 

Q - Is there health insurance for pre-existing conditions?

A - Yes, nowadays, there are many health insurance plans offered for individuals having a pre-existing condition. 

Q- Could my health plan have a pre-existing condition-waiting period?

A- Yes, in India, health insurance plans can impose a waiting period for individuals having a pre-existing condition. This waiting period typically ranges from two to four years. 

Q - How do pre-existing conditions affect the premium of the health insurance plans?

A- Preexisting conditions are already diagnosed medical conditions of an individual before he takes up an insurance policy, such that it would put financial implications on the insurer in the future, that’s why the insurance companies charge higher premiums or waiting periods for the pre-existing conditions.