Can you Get Health Insurance Cover if you have a Pre-existing Disease?

Nowadays, health insurance has gained popularity in India. However, some people prefer to stay away from medical insurance because of their pre-existing medical conditions like diabetes, BP, thyroid, heart ailments, etc. In India, health insurance for pre-existing diseases is available, but some points are associated with its coverage and limitations, so read on to know more in detail.

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      Applicants with pre-existing diseases are worried that the insurer won’t cover them. And they will only get nominal coverage in case of any hospitalization. This is a myth that most people have regarding medical insurance cover.

      Because there is stiff competition in the industry, more and more companies are offering medical insurance plans after the COVID-19 outbreak. Almost all the insurance companies provide coverage to those with Pre-existing diseases or PED and the only difference is that the premium is on the higher side. The policy coverage benefits are similar to those provided to a normal person.  

      Due to the increasing competition in the industry, companies are now willing to take risks associated with pre-existing diseases. In fact, you have the option to choose the best medical insurance policy that covers pre-existing conditions as per your needs and preferences.​​​

      What are Pre-existing Illnesses?

      Pre-existing illnesses are medical conditions that are already present when a proposer plans to buy a medical insurance cover. Health problems like diabetes, asthma, cancer, which a person might have before the commencement of pre-existing illnesses. Insurers cannot refuse to cover treatment for your pre-existing conditions or charge you more unless it is specifically mentioned in the policy wordings.

      Since mediclaim plans work on risk basis, many insurance providers have a clause related to pre-existing illnesses. For example, no claims can be made for a pre-existing illness in the initial two years of the policy cover. Waiting periods are usually applicable to pre-existing ailments. As per the IRDAI, new guidelines have been issues that define any illness that has been diagnosed within 48 months of an ailment/illness/disease that has been diagnosed by a doctor before issuing the policy will be classified as a pre-existing illness.  

      The problem lies in the definition of the pre-existing conditions that vary from one insurance company to another. Many insurance companies term diabetes and other cardiovascular illnesses as pre-existing conditions. And due to these ambiguities in the definition of pre-existing illnesses, the picture is not clear to the common man who is suffering from any such pre-existing medical condition and thus they prefer to skip spending on medical insurance plans.

      With changing times and the entry of new insurance players in the health insurance sector, the picture is now getting clear. More and more people who are suffering from any ailment related to stress are getting more inclined to buy coverage and protect themselves from any illness occurring due to medical emergencies.

      So, when you are buying health insurance or a critical illness policy it is your duty to inform the insurance company about the diagnosed illnesses, surgery, medical history of illness, accidental injuries, and furnish medical reports before buying the policy. It is also important to understand the type of diseases that insurance companies define as a pre-existing illness to avoid problems at the time of claim settlement.

      At times when the policy is issued without any pre-medical screening and the insured gets sick and needs hospitalization then the claim can get rejected if it was filed for some pre-existing conditions. So to avoid unnecessary stress and hassle it is important to undergo medical tests before signing the policy documents.​

      How to get health insurance in India for pre-existing diseases?

      It is possible to buy health insurance in India even if you have a pre-existing disease. Almost every health plan covers people with these illnesses including diabetes, asthma, hypertension, or get enrolled, but after the completion of the waiting period. You simply need to wait for the waiting period to be over and then start filing a claim when you need to do so.

      Nowadays, there are some medical insurance plans that include existing medical conditions from the date of policy commencement. So, now you must be clear that getting health insurance cover even with pre-existing health disorders is no longer a problem.

      Points to remember when buying health insurance in India for pre-existing diseases

      Before you buy health insurance with pre-existing ailments, make sure that you go through some of the points as given below:

      • Policy premium amount- It is important for you to know that the health insurance company is providing the health cover to you at a risk. As a result, the cost of the premium is higher, which is quite understandable. An applicant with an ongoing medical condition is more likely to file a health insurance claim. And to cover the risk, health insurers charge a higher premium and the policy becomes expensive.
      • Importance of medical screening- If there is an option; you should prefer to undergo medical screening before purchasing health insurance in India with pre-existing medical cover. It will ensure that there are no disputes at the time of claim settlement. If you undergo medical tests and truthfully reveal your health conditions at the time of policy purchase, the insurer cannot deny the claim later on. So why not do it at the time of medical screening when you are purchasing the policy.
      • Proper usage of group insurance - If you are a corporate employee or have a government job then you must be insured under a group health insurance policy as well. Central government employees are insured under the CGHS. As it is an employer provided health insurance policy, the health insurance policy doesn’t have any waiting period clause. You can make use of your group health cover wisely and get compensation for treatment taken for pre-existing ailments.

      Bottom-line

      As you can see those with PEDs to get medical insurance coverage in India. So, let the misconception take a backseat and secure your life and your loved ones’ life with an adequate health insurance policy. It allows you to undergo treatment in the top-most hospital with modern treatment facilities, especially during the Coronavirus pandemic.

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      *All the health insurance plans cover hospitalization expenses including COVID-19 treatment cover up to the specified limits. You can also buy specific COVID-19 health insurance policies such as Corona Kavach Policy and Corona Rakshak policy.

      **All savings and online discounts are provided by insurers as per IRDAI approved insurance plans. #Tax Benefits are subject to changes in tax laws. GST Exemptions depend on fulfilment of qualification criteria and submission of relevant documents.

      *₹1748/month is the starting price for a 1 crore health insurance for an 18-year-old male, with no pre-existing diseases. Discount on renewal premium is subject to the number of wellness points earned in the health insurance policy. For more details about the plans, please read the sale brochure carefully to get upto 100% discount on renewal premium.

      *₹400/month is the starting price for ₹ 5 lakh Health insurance for a 30 year old male & 29 years old female, living in Delhi with no pre-existing diseases

      *₹541/month is the starting price for ₹ 10 lakh Health insurance for a 30 year old male & 29 years old female, living in Delhi with no pre-existing diseases

      *₹762/month is the starting price for ₹ 1 Crore Health insurance for a 30 year old male & 29 years old female, living in Delhi with no pre-existing diseases

      *₹243/month(₹ 8/day) is the starting price for a 5 lakh health insurance for a 20-year-old male, non-smoker, living in Bengaluru with no pre-existing diseases

      *₹2020/month is the starting price for ₹ 1 Cr Health insurance for a 50 year old male & 50 years old female, living in Bangalore with no pre-existing diseases rounded off to nearest 10.

      *₹390/month (₹13 per day) is starting price for 1 cr. Health insurance for 25 years old male, with pre-existing diseases, residing from tier 1 city rounded off to the nearest 10.

      *No medical tests are required unless requested by the insurer’s underwriter. In-case of pre-existing diseases relevant medical proof would be required as per the terms and condition of the policy opted.

      *The values taken for effective cost calculation are indicative values and may change as per the selected plan.

      *Coverage upto double the amount of Sum Insured is available on certain covers for a minimum plan of Rs. 5 Lakh on the first claim only to an individual of upto 45 years of age with no pre-existing diseases. The benefit is available with or without extra cost depending on the plan chosen.

      *Coverage of pre-existing diseases is provided by insurer as per their underwriting policy.

      *The scope of coverage may vary from plan to plan.

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