Pre Existing Disease Health Insurance

What is the Pre-Existing Diseases Waiting Period?

As the name suggests, the pre-existing disease waiting period in health insurance plans is when you must wait before you start to utilise your policy’s benefits for the existing health conditions. It occurs from the policy’s inception date, and the policyholders can’t file a claim during this period. The waiting period for medical insurance for pre-existing conditions varies from one insurance provider to another.

Types of Waiting Periods under Health Insurance Plans

There are four main types of waiting periods in health insurance plans they include:

• Pre-existing Diseases (PED) Waiting Period: If the insured has high BP, diabetes, etc., while buying a health insurance plan, these are considered pre-existing diseases. Mostly, health cover for pre-existing conditions is activated after serving a waiting period of 2 to 4 years.
• Waiting Periods for Named Ailments/Procedures: There are specific ailments & procedures, such as joint replacement, ENT disorders, cataracts, etc., with the named ailments waiting at least two years.
• Initial Waiting Period: All health insurance plans have an initial waiting period of 30 days. During this duration, no claim is accepted except for accidental ones.
• Maternity Benefit Waiting Period: Maternity insurance benefits mothers and new born babies. You can get coverage only after serving a notice period varying from 9 months to 36 months.

Why is it Necessary to Disclose PEDs While Buying a Health Insurance Policy?

People often make the mistake of not revealing pre-existing illnesses while buying insurance for pre-existing diseases, and no company encourages this. You must know that specific plans like ‘Care Freedom’ offer a two-year waiting period. You can purchase this plan on an individual or a family floater basis. Here’s why disclosure is critical:

• Claim Validity: Non-disclosure might cause claim denial if the insurer discovers the disease was pre-existing and not announced.
• Policy Approval: Insurers evaluate risk depending on health conditions; disclosure helps them to offer ideal plans or coverage.
• Waiting Period Clarity: Most policies have a waiting period for PEDs; disclosure guarantees accurate tracking and application of this period.
• Legal Compliance: Giving false or incomplete information can be considered fraud, causing policy cancellation.
• Premium Accuracy: Accurate disclosure helps insurers in setting the right premium based on risk.
• Peace of Mind: Knowing your pre-existing illness health insurance is valid brings reassurance.

How Does a Pre-existing Disease Affect Your Health Insurance?

A pre-existing disease (PED) can impact your health insurance terms, cost, and benefits. Here are the key impacts:

• Waiting Period Imposed: Most insurance providers impose a waiting period of around 2–4 years before covering PED treatment.
• Higher Premiums: Insurers may charge higher premiums due to increased health risk.
• Coverage Restrictions: Some health insurance plans covering pre-existing diseases may have limits.
• Medical Underwriting: Insurance providers may need medical tests before policy approval, specifically for senior citizens.
• Policy Rejection Risk: In extreme cases, the insurer might deny the application if the risk is deemed too high.
• Need for Disclosure: Failure to disclose a PED can lead to claim rejection or policy cancellation later.

Tips to Buy Health Insurance for Parents with Pre-existing Conditions

If your parents have a pre-existing condition, consider the following before choosing the best health insurance for pre-existing conditions:

• Waiting Period: Choose a family health insurance policy with minimal waiting time.
• Sum Insured: Go for higher coverage for safety.
• Medical check-ups: Sometimes optional.
• Affordable Premium: A key factor when comparing the best health insurance for pre-existing conditions.

Things to Consider While Buying a Health Insurance Plan for Pre-Existing Diseases

To find the best medical insurance for pre-existing conditions, keep the following in mind:

• Identify Pre-existing Diseases: Minor health issues, such as cough, cold, and fever, are not pre-existing diseases. Not every ailment is a pre-existing disease. A list of pre-existing conditions is admissible for the claim under the health insurance coverage, subject to a waiting period.
• Disclose complete information: Never hide your medical condition that may affect your chances of getting a health insurance policy or lead to claim rejection if any pre-existing condition is found later.
• Pre-policy medical check-up: The underwriter may require a policy buyer to undergo a pre-policy medical check-up.
• Waiting Period: Health insurance plans with pre-existing disease coverage have a waiting period of 36 months. However, with waiting period waiver add-on, you can reduce the years up to 2 to 1 year as per the policy terms.
• Premium: Premiums are higher in medical insurance for pre-existing conditions due to higher risk.

Effects of a Pre-existing Disease on Your Health Insurance

Understanding the effects helps you navigate your options when choosing insurance for pre-existing disease:

• Higher Premiums: Insurance service providers usually charge hefty premiums to cover the additional risk for policyholders with pre-existing conditions. The severity of the condition influences the premium hike.
• Exclusions or Waiting Periods: Some policies impose waiting periods before offering coverage for a pre-existing condition. This means that the insurance may not cover expenses related to the disease for a specified duration (e.g., 1-4 years).
• Limited Coverage: Depending on the insurer, the policy might not include treatment for particular pre-existing conditions. This can be incredibly impactful if the condition needs continuous treatment or medication.
• Coverage Denial: In some cases, an insurer can reject coverage for people with certain pre-existing conditions, especially if the condition is considered high-risk (like cancer or heart disease).
• Disclosure Requirement: When applying for health insurance, disclosing any pre-existing condition is essential. If the policyholder doesn't fulfil this term, it can result in claims denial or coverage cancellation if discovered later.

Why Do Health Insurance Companies Avoid Covering Pre-Existing Diseases?

Health insurers are cautious with health cover for pre-existing conditions because:

• High Initial Risk: PEDs usually need continuous or costly treatment, making claims more likely early in the policy.
• Adverse Selection: Without PED exclusions, only sick people might buy insurance, causing losses for insurers.
• Cost Control: Excluding or delaying PED coverage helps insurers keep premium costs manageable for all customers.
• Facilitates Early Enrollment: It encourages people to buy health insurance early, before illnesses grow.
• Risk Pool Management: Restricting PED coverage helps maintain a balanced and sustainable insurance pool.

Why Should You Choose Care Health Insurance?

Selecting the right health insurance is essential, particularly if you have pre-existing diseases (PEDs). Care Health Insurance offers trustworthy and transparent plans designed to provide exhaustive coverage for PEDs after a suitable waiting period. With adaptable options and strong customer support, it guarantees you get the care you need without added stress. When considering health insurance for pre-existing conditions, Care Health Insurance is a wise option because:

• Plans include pre-existing illness health insurance after waiting 3 years.
• Add-ons allow you to reduce the PED waiting period.
• Transparent coverage and hassle-free claims make it the best health insurance for pre-existing conditions.
• Transparent PED clauses help avoid confusion during claim settlement.
• Get cashless treatment for covered PED-related conditions at network hospitals.
• Efficient handling of PED-related claims with minimal paperwork.