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Pre-existing disease in health insurance is a condition an individual already suffers before purchasing an insurance policy. A pre-existing disease typically affects health insurance through higher premiums, waiting periods, exclusion or denial of the policy.
The significance of a comprehensive health insurance plan cannot be stressed enough in today's time. With more people affected by lifestyle diseases, especially after the COVID-19 outbreak, medical insurance has secured a place in most individuals' financial plans like never before.
Although having a health insurance policy is imperative, getting it early in life and not solely depending on employer-funded insurance plans are two critical aspects most people usually ignore. The negative impact of this decision is- not being adequately covered for pre-existing diseases.
In the article below, we shall discuss a pre-existing disease in a health insurance plan, its impact on your insurance plan, benefits of having pre-existing health insurance, and a few things to consider while buying a mediclaim policy for a pre-existing disease.
What is Pre-existing Disease Cover in Health Insurance?
Health insurance pre-existing conditions are those an individual suffers or is diagnosed with before obtaining health coverage. These diseases or conditions may range from mild to high in severity.
According to the Insurance Regulatory and Development Authority of India (IRDAI), if an individual is diagnosed with a health condition 48 months before obtaining a health policy, it is considered a pre-existing disease (PED).
Hence, if you suffer from a health condition that you are unaware of or was not diagnosed before the policy came into effect, it will not be termed as a pre-existing disease. Common PEDs include high blood pressure, thyroid, asthma, etc.
Effects of a Pre-existing Disease on Health Insurance
Health insurance premiums are charged based on the likelihood of a high-amount claim from the insured, putting the insurance provider at a higher financial risk. It is common knowledge that people with pre-existing conditions are more likely to file frequent claims than others. Thus imposing higher financial risk on the insurers.
To avoid these risks, most insurance providers avoid offering coverage to people with pre-existing diseases. Even if they do, the health insurance often gets affected by the following:
Premium loading: The premium charged to an individual with a pre-existing disease is typically higher than the one without a PED. This is because the insurance provider is at higher risk of facing frequent claims due to health conditions.
Usually, this premium loading is applicable at the time of policy purchase and not at the time of renewal if the policy continues without interruption.
Waiting period: The pre-existing diseases waiting period is when the insured must wait for the PED to be covered by the insurance policy. The insurance company does not cover any claim raised during the waiting period.
There are no standard pre-existing disease waiting periods; they may depend on the type of illness, the coverage offered, the insurance company, etc.
Combination of premium loading and waiting period: If the medical condition to be covered is severe, insurance companies may offer coverage at a higher premium with a more extended waiting period.
Medical check-up: Many insurance providers may ask individuals for a medical check-up, especially for pre-existing diseases. The premiums are levied based on the test results.
Exclusion: Insurance companies may offer health insurance but put the pre-existing condition under its exclusions. In this way, you may not get adequately covered but may still have the coverage.
Denial: In some cases, the insurance provider may decide not to offer the coverage due to the high risks involved.
Benefits of Having a Pre-existing Disease Insurance
If you already suffer from a PED, having a pre-existing disease to cover health insurance is better. Remember to disclose all your pre-existing conditions to your insurance provider and read the terms and conditions, coverage, waiting period, etc., before opting for a plan.
Here are some key benefits of a pre-existing disease insurance:
It provides financial protection against high healthcare costs associated with these conditions.
It offers timely and uninterrupted care, which is required to keep the existing condition under control.
Most pre-existing disease cover in health insurance offers holistic coverage, including hospitalisation costs, consultations, surgeries, diagnostic tests, etc.
You get access to high-quality medical treatment from reputed healthcare providers.
Things to Know While Buying Health Insurance for Pre-existing Disease
Never hide a pre-existing illness.
Not all conditions are categorised under pre-existing ailments.
Get a voluntary and regular health check-up done.
Different providers have different policy terms and conditions, inclusions and exclusions, waiting periods, etc.
Always compare plans before buying.
The waiting period can be reduced by paying higher premiums.
Conclusion
Health insurance has become a necessity in recent times. Moreover, individuals with pre-existing conditions must know the aspects, as mentioned earlier, that may impact their insurance coverage and premium payable. Along with having adequate health insurance coverage, purchasing it from a trusted provider is equally important. Choose a provider that offers plans as per your needs, a facility for cashless and reimbursement claims, digital support, and various other benefits at affordable rates.
