Busting some myths around health insurance coverage for pre-existing diseases

There is a common misconception that if one is suffering from a pre-existing condition, they may not be eligible to get a health insurance policy at all.

Amit Chhabra, MintGenie Team
First Published8 Jun 2022, 12:38 PM IST
Every insurer offers health insurance policies to people with pre-existing diseases.
Every insurer offers health insurance policies to people with pre-existing diseases.(Pixabay)

The recent COVID-19 pandemic has been a stark reiteration of the fact that having a solid health insurance plan with adequate coverage is not a choice anymore, but a necessity. Amid rising medical costs and an increased risk of contracting infections, financial protection against unplanned medical expenses is the prudent way forward. However, as one’s age increases, it often becomes difficult and expensive to get covered, especially if one is already suffering from an ailment.

In fact, there is a common misconception that if one is suffering from a pre-existing condition, they may not be eligible to get a health insurance policy at all. And somehow, if they are able to manage to get a policy from a good insurer, they believe that the extent of coverage may not be enough to cover their hospitalisation cost, particularly if the reason for hospitalisation is related to their pre-existing ailment.

On the one hand, this leads many people to skip buying a health insurance policy altogether. On the other, people end up hiding their pre-existing conditions while buying a health plan. Both these choices can prove to be disastrous for the individual. While not having coverage would mean they would have to pay the entire hospital bill out of their own pocket, the failure to disclose the true state of their health while buying a policy may lead to their claim being outrightly rejected.

Health insurance cover for pre-existing diseases

First and foremost, every insurer offers health insurance policies to people with pre-existing diseases. The only catch is that there is a waiting period involved for the coverage to start for that specific pre-existing condition. During this waiting period, the policyholder cannot make any claim for hospitalisation due to the pre-existing illness. This also holds true for doctor fees and the cost of medicines that may be ongoing requirements.

Say, for example, if an individual suffering from diabetes buys a policy, he/she would get coverage against every other ailment except diabetes as soon as the policy kicks in, normally 30 days from purchase of the policy. The coverage for diabetes, however, also starts after a waiting period specifically mentioned in the policy document, which can be anywhere between two to four years. So instead of hiding the state of health at the time of policy purchase — which could lead to complications while filing a claim — the policyholder should simply declare the pre-existing disease and enjoy coverage against it, albeit after a waiting period.

However, if the exclusion of pre-existing ailments during the waiting period still remains a matter of concern for you, the good news is that many insurers have come up with specially-designed plans that offer coverage against pre-existing diseases from day one, or with a waiting period as low as one to three months. This means even those suffering from ailments like hypertension, asthma, diabetes or high cholesterol level, can opt for a Pre-Existing Disease (PED) cover which starts protecting them as soon as they purchase the policy.

While it is true that the option to reduce the waiting period for pre-existing diseases existed earlier as well, however, with relaxed underwriting norms, this has become much more affordable. As per industry insights, these plans are 40 percent cheaper than their variants in the past.

How to choose a policy if you have a pre-existing disease

Since different insurers have different rules, terms and conditions for their health insurance plans, it is wise to compare multiple plans and their treatment for pre-existing ailments. By doing so, you can narrow it down to a plan that suits your unique needs. The good news is that with the digital revolution that we have seen over the last decade or so, it is very easy to compare plans online, offered by different insurers.

While comparing plans, look for the waiting period that they offer with respect to the pre-existing diseases. Also, check if they require you to undergo any medical tests before buying the policy. Once you have narrowed down a plan, check if the plan has the option to further lower down the waiting period by paying an extra premium, or if there is an optional PED cover that it offers. If so, how much does it costs and to what extent does it lowers the waiting period?

Most importantly, make sure you clearly specify the pre-existing ailments you suffer from while buying the policy. As per the new definition of pre-existing diseases issued by the Insurance Regulatory and Development Authority of India (IRDAI), pre-existing illness is a medical condition, sickness, disease, or injury, that has been diagnosed in the insured person by a physician before the purchase of a medical insurance plan. Customers are advised to declare surgeries done in childhood or heart conditions that occurred prior to seven years. This is suggested because underwriting depends on such factors. So, one should disclose any medical history be it a surgery, COVID-19 or any ailment that has occurred in his/her lifetime. This is to ensure that one’s claim is paid out and is not rejected due to non-disclosure of PEDs.

So the bottom line is that whether you are healthy, or suffering from a pre-existing ailment, you should get yourself covered by a health insurance policy at the earliest. It is all about being informed and selecting the policy that is right for your specific requirements.

Amit Chhabra, Head - Health and Travel Insurance, Policybazaar.com

Government Health Insurance Schemes in India
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First Published:8 Jun 2022, 12:38 PM IST
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