Things you must know about pre-existing diseases and health insurance

Neha, a young technology professional, used to believe that health insurance was not for her. She has a pre-existing heart condition that made her believe, like many others, that no insurer would cover her treatment in case of an emergency. Neha believed this because she was misinformed, until she talked to a friend who gave her proper advice and information that health insurance in India does cover a number of pre-existing diseases, subject to a few terms and conditions. If you too, like Neha, want to know more, read on.

What are pre-existing diseases (PED)?

Pre-existing diseases are health problems which are known to the applicant at the time of first purchase of the health insurance or are detected during the pre-sale check-up conducted by a health insurance company. Generally, insurance companies have set lists and guidelines to decide what can be classified as a pre-existing disease. They may make the decision based on many factors, including demographic, actuarial and medical ones.

PED is covered, except for a few permanent exclusions

Many people are still under the wrong impression that insurance carriers in India do not cover pre-existing diseases at all. Nothing can be far from the truth. Fact is, many general insurance companies do offer cover for pre-existing problems, except for some very expensive and life-threatening diseases, which cost a lot to treat. HIV and cancer, for instance, are considered as permanent exclusions. Other than this, the policy form and documents have lists of which pre-existing diseases are covered.

The concept of waiting period in health insurance

The concept of waiting period has been introduced in order to ensure that health insurance companies are able to provide equitable service to people and protect their bottom line simultaneously. Insurance companies are allowed to enforce a waiting period of up to 48 months for covering PED. They usually tend to grade the waiting period.

• During the first 30 days after a policy is sold, the insurance company does not provide any kind of health cover except for injuries caused by an accident. This may cover motor vehicle accident related injuries or other kinds as defined by policy terms and conditions.
• 48 months waiting period for pre-existing diseases: While new ailments are covered from the next day when 30 days waiting period expires, most insurance companies tend to enforce a 48-month waiting period on pre-existing diseases. No cover is provided for any allowed pre-existing problem during this period.
• Post 48 months of policy purchase: Insurance companies can cover agreed pre-existing diseases after first four years/48 months have passed since policy purchase. This is subject to the fact that the policy has been in good standing and no premium payment has been missed during the 48 months.

Premium loading can provide immediate help

In order to ensure that more people can avail the benefits of health insurance, insurance companies are also allowed the option of premium loading. With premium loading, a policy buyer can bear a higher premium cost to reduce or mark-off the 48-month PED waiting period. Premium loading is a good solution for people with diabetes and heart problem. IRDA also ensures that premium loading cannot be done for any disease that may occur after policy has been issued, subject to its timely renewals.

Thus, Neha now knows that her pre-existing heart condition can be covered by health insurance in India. All she has to do is either wait for four years or go for premium loading. So, hopefully, you too can make the right choice and prepare for eventualities.

 

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