Does Group Health Insurance Cover Pre-Existing Illnesses?

If you run a company then providing group health insurance to your employees is a way of showing gratitude for their service. A group plan protects your employee financially from any unforeseen medical expenses. However, purchasing a group plan that fulfills every employee’s requirements is not easy. This is why it is advised to purchase a plan that provides comprehensive coverage so that nothing stays left out. But what about the pre-existing diseases cover?

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Are Pre-Existing Diseases Covered Under Group Health Insurance For Employees?

The answer is yes. Group health plans provide coverage for pre-existing diseases. There are many group health plan providers that offer this kind of coverage in their basic plans. In case a company does not provide this cover then you can add a rider such as pre-existing disease waiver.

So let us tell what is a pre-existing disease?

Pre-Existing Disease

The pre-existing disease is a disease with which the insured person has been diagnosed before purchasing the insurance plan. The disease will be considered as pre-existing if it has been diagnosed within 48 months of the purchase of the policy. Pre-existing itself suggests that disease already exists in the person.

For example, Ramesh is an employee of an XYZ company. The company provides him with an insurance plan. Ramesh is suffering from Asthma for the past three years. When Ramesh will enroll in the group health plan program then he will have to mention this disease in the pre-existing disease section in the insurance form and he will be provided financial cover for the medical expenses coming out of this disease.

Pre Existing Diseases In Group Health Plan

If the insurance policy provides cover for pre-existing diseases then the details related to it will be specified in the certificate/document of the insurance plan. A group plan is mostly purchased for the employees of a company. Post issuance of the plan the employees get a policy card with their names on it. The employee can learn more about the plan by getting in touch with the HR or admin of the company.

Is Medical Test Required Before Purchasing Group Health Plan?

If you purchase an insurance plan for yourself only then you will have to go through some medical tests and then the insurance company will issue the plan and charge the premium accordingly. But in a group health insurance policy, there is no need for any medical test.

However, employees can customize the insurance plan but they will have to pay an extra amount for the added cover. Pre-existing diseases are usually covered under the group health plan but in case of additional cover, the employee will have to go through a series of medical tests as well as they will have to tell the insurer about the pre-existing diseases. The employee will have to follow the protocol.

Are Pre-Existing Diseases Covered Under From Day 1?

Yes, pre-existing diseases are covered from day one under some group health plans. The employee can raise a claim for unforeseen medical expenses without waiting for a period of time. There is no waiting period for getting the cover. It is advised to consult with the insurance provider and clarify any kind of doubt that you might have.

Should One Add Pre-Existing Disease Waiver?

If the existing group health plan does not provide cover for the pre-existing diseases then you can add a waiver of Pre-existing diseases to provide wider coverage to your employees.

For example, if you have a group of employees who are older than 30 years of age then there are chances that they are suffering from a pre-existing disease. This is why it would be a better idea to purchase a pre-existing disease waiver if the existing policy does not provide it.

Features Of Group Health Insurance Provided By Employer

There are several features that can be beneficial for an employee covered under a group health plan. They are as follows:

Benefits of Insurance

  • The coverage can be increased if not satisfied.
  • The family members can be included in the plan.
  • You do not have to serve any waiting period for pre-existing diseases.
  • Covid-19 is also covered.
  • Out-patient treatments are covered.
  • The claiming process is seamless.

Other Benefits

  • The insurance companies have started providing telemedicine through mobile apps
  • Several discounts are provided on the medical lab tests and medicines
  • If you complete a fitness challenge then you will be rewarded
  • You can also get access to mental health and nutritionists sessions.

What Is The Significance of Group Health Plan?

Let us tell you the significance of group health plans for both employer and employee.

For Employer

  • Providing a group health plan to the employees reflects the goodwill of the employer among the employees and shows that he cares for the employees.
  • The employee becomes more loyal towards the company and works harder.
  • It creates a healthy workforce in the company because the burden of the medical expenses gets off of the employee's shoulders and they feel free.

For Employees

  • The employee gets the medical coverage for free unless they increase coverage.
  • In a medical crisis, the employee can reach out to the insurer easily through the HR or Admin of the company.
  • The dependents of the employee get medical coverage.
  • The employee does not have to hassle much for claim settlement.


Providing a group health insurance plan to the employees shows that you care for your employees and their dependents. It is recommended by the insurance experts to purchase the insurance plan online because it is cost-effective and you can learn about the policy in detail. It cuts off the agent’s fee and you can calculate the insurance premium rate using the online premium calculator.




Written By: PolicyBazaar - Updated: 27 August 2021

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