Home >Insurance >News >Pre-existing diseases in health insurance: All you need to know
In case of enhancement of sum insured, the exclusion and waiting period will apply afresh to the extent of sum insured increase. (Photo: iStock)
In case of enhancement of sum insured, the exclusion and waiting period will apply afresh to the extent of sum insured increase. (Photo: iStock)

Pre-existing diseases in health insurance: All you need to know

Most health insurance policies cover pre-existing diseases after a specified period called as the 'waiting period'.

Pre-existing diseases are those medical ailments that the insured person already suffers from at the time of purchasing a new health insurance policy. IRDAI defines pre-existing disease as a) any condition, ailment, injury or disease which is diagnosed by a physician within 48 months prior to the effective date of the policy issued by the insurer or its reinstatement or b) for which medical advice or treatment was recommended by, or received from, a physician within 48 months prior to the effective date of the policy issued by the insurer or its reinstatement.

IRDAI has mandated that all existing health insurance products that are not in compliance with this definition shall not be offered and promoted from 01st October, 2020 onwards.

Waiting period for pre-existing diseases

Generally, most health insurance policies cover pre-existing diseases after a specified period called as the 'waiting period'. Waiting period for pre-existing diseases varies from one year to four years of continuous coverage after the date of inception of the first policy with insurer. On completion of the waiting period, the insurance company will start covering pre-existing illnesses.

In case of enhancement of sum insured, the exclusion and waiting period will apply afresh to the extent of sum insured increase.

Disclose pre-existing diseases clearly

Health insurance policies almost are sold and purchased in 'utmost good faith'. If you hide any information at the time of filling the application form, the insurance company can reject your claims in future on the basis of false information. If you want to avoid any such claim rejection, you should disclose your pre-existing conditions and every other detail honestly.

Check for shorter waiting periods

You must disclose all the medical conditions to the best of your knowledge. It is crucial to go through the policy exclusions and waiting period thoroughly before buying a health insurance plan. You can compare the policies and go for the one which has a lower waiting period if you suffer form any ailment at the time of purchasing the policy.

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