Myth : Pre-existing Conditions are Never Covered Under Health Insurance

Posted on: Jun 5, 2025 | 3 mins | Written by: HDFC ERGO Team

Myth : Pre-existing Conditions are Never Covered Under Health Insurance

While looking for the best health insurance, many think their medical condition will bar them from receiving coverage. However, the reality is that pre-existing conditions can be included in a health insurance policy with certain conditions. Also, remember that any condition you develop after your policy starts or any undiagnosed ailment that you were unaware of before purchasing your policy will not be considered pre-existing.

What is a Pre-existing Condition and How It affects Health Coverage?

A pre-existing condition in health insurance means any illness, disease, or condition that you had been diagnosed with or even treated for before you apply for a policy.

Some of the pre-existing health conditions are.

• High blood pressure (hypertension)

• Diabetes

• Asthma

• Thyroid disorders

• Heart disease

• Chronic back pain or other joint problems

Now let’s see how different factors influence health insurance coverage for pre-existing conditions:

Waiting Period

Most plans impose a waiting period (2-4 years) before covering treatment related to a pre-existing condition. Once this period is over, you’re eligible to file claims for those conditions.

Waiting periods may feel unfair, but they serve a purpose for both parties, like:

• Prevent misuse of insurance:

It prevents the misuse of insurance by certain people to get coverage for pre-existing medical needs, which they have already anticipated.

• Promote long-term planning:

It encourages people to purchase health insurance before being diagnosed with chronic conditions.

• Balance risk for insurers:

Waiting periods help insurers manage their financial risk while still offering coverage.

Premium Loading

You may be subject to a marginally increased premium based on the estimated risk associated with your health history.

Medical Tests

The insurance provider may require a medical check-up to effectively assess the current state of your condition before issuing a policy.

Permanent Exclusions

In rare cases, a particular condition might be permanently excluded from your policy. It is important to read the policy document carefully.

Why You Should Never Hide Your Pre-existing Conditions?

Being transparent is not just a moral obligation; it's also a smart decision when looking for the best health insurance.

Here are a few reasons why you should always be honest:

• Avoid Claim Rejection:

If a claim is linked to an undisclosed condition, it may be denied.

• Start the Waiting Period Quickly:

Your waiting period begins once you inform the insurer about your medical history. You can prevent any delays and make your way to receive benefits by declaring early.

• Understand Limitations:

Full disclosure allows the insurer to be upfront about exclusions and limitations, helping you make better decisions.

• Seamless Portability:

If you switch insurers later, your disclosed condition and accumulated waiting period will carry forward.

Can You Get the Best Health Insurance with a Pre-existing Condition?

Absolutely yes! Follow the tips below to get the best health insurance if you have a pre-existing condition:

• Evaluate Plans by Waiting Periods:

Choose a policy with the shortest waiting time for your medical condition.

• Avoid Plans With Co-Payment Clauses:

These require you to pay a percentage of the treatment cost. Look for plans that have no or low co-payments.

• Don’t Panic About Doctor Visits:

Not every consultation counts. A seasonal flu visit doesn’t make it a pre-existing condition — only long-term or chronic illnesses do.

• Disclose, Always:

Honesty protects you legally and financially.

Conclusion

The notion that you cannot receive health insurance because you have a pre-existing condition is not true. When you are clear about your health conditions and waiting periods and analyse alternatives carefully, you can get the best health insurance. Therefore, do not let old beliefs get in the way of securing a financial safety net regarding your health.

Disclaimer: The above information is for illustrative purposes only. For more details, please refer to the policy wordings and prospectus before concluding the sales.

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