A Guide on the Concept of Pre-Existing Diseases in Health Insurance - Greyfont

Concept of Pre-existing Diseases


Having a disease means eventually having to spend money on its treatment. And that’s why health insurance policies have come into being to take care of your medical expenses. With the rising medical costs and inflation, having a health insurance policy is must. However, for people having any pre-existing condition, getting a health insurance policy is difficult.


What is pre-existing disease?


A pre-existing disease is any medical condition that a policyholder is suffering from at the time of buying a health policy. Diseases or medical conditions such as Asthma, Hypothyroidism, Hyperthyroidism, Heart Ailments, Hypertension, Diabetes Mellitus and Thalassemia and others is considered as a pre-existing disease.


Under the following circumstances, insurance companies consider any ailment as pre-existing:


  • If the policyholder/policy seeker has any major accidental history or was earlier in the past hospitalized due to illnesses such as cancer, heart attack, diabetes and others.


  • If the policyholder has any signs or symptoms or is on medication due to obesity, psoriasis, asthma, cholesterol, hypertension, acidity and others.


  • Any disease or ailment that is existing but is unknown to the policy seeker and gets detected


How does pre-existing disease have an impact on your health insurance?


Individuals having pre-existing diseases are at a much higher risk of requiring medical assistance and this is the main reason why insurance companies are a bit reluctant to provide coverage to such individuals. Not letting our insurance company about your pre-existing medical condition can result in claim refusal or even cancellation of the policy.


Facts to know if you have a pre-existing disease


  • Health policies differ from insurer to insurer: Different insurance companies have varied terms and conditions when it comes to providing coverage for pre-existing diseases. Few insurers may ask you to get a medical check-up done, while few may collect the policy seeker’s medical history dating back to 3-4 years or few might also consider your entire medical history.


  • Every trip to the doctor or small medical conditions do not matter: Minor ailments or conditions such as cough, fever or cold cannot be considered as pre-existing disease as these are short-term problems leaving no long lasting effects.


  • Do not hide your pre-existing ailment:Hiding your pre-existing disease from your insurer might result in rejection of claim and even cancellation of the policy.


  • Waiting period: If you have any pre-existing medical condition, then your insurer would not provide you any coverage for against those specified illnesses for a few years. Individuals with pre-existing disease have a waiting period only after which they will be provided medical coverage. Waiting period is usually 2-4 years and it’s also important to understand that waiting period for different diseases might wary and also depend on your insurer.


  • High premium: Insurance companies charge you a high premium if you have any pre-existing disease. However, IRDA guidelines clearly mention that insurance companies cannot charge an additional premium to customers getting any diseases after the issuance of the policy.


  • Medical check-up: It’s always advisable to undergo medical check-up before buying a health insurance policy to prevent your claims from getting rejected. Also, the insurance company can ask you to undergo a medical check-up depending on which they can decide whether to provide you coverage or not. Insurer can also permanently exclude your pre-existing disease or provide coverage after waiting period. They can also deny you coverage if you have had a history of any chronic pre-existing ailments such as cancer, diabetes, heart attack, etc.


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