All You Need to Know About Pre-Existing Disease in a Health Insurance Plan

Health insurance plans have become a necessity. And for people with pre-existing diseases, buying comprehensive medical insurance can be a daunting task. So, before we start discussing the limitations in coverage for pre-existing illnesses, it is important to know what does a 'pre-existing health condition actually means.

A pre-existing illness means any health issue that the proposer has been facing prior to purchasing a health insurance policy. The pre-existing conditions include all the health issues ranging from high blood pressure, thyroid, the usual suspects like diabetes, asthma, etc.

Health Insurance Companies Dislike Pre-existing Diseases

Insurance providers are apprehensive to provide health insurance cover to people suffering from pre-existing illnesses. It is because people with pre-existing illnesses are more likely to file a claim and thus, impose a higher financial risk to the health insurance providers. It is not easy to predict sickness in advance, but an insurer may be aware of people who are already suffering from health problems. Harsh truth, even the health insurance companies are working towards a profitable business.

Buying Insurance If You Have Pre-Existing Health Issues

The problem is that people with pre-existing health issues often have to undergo various procedures. This could mean refusal from the insurer to pay the bill, cancellation of coverage, or even straight of your medical insurance policy.

You must be wondering how to work around this issue? Here is a quick rundown of some useful tips to help find the best health insurance policy for yourself, especially if you have some existing health issues:

1. Different Insurance Companies Have Different Policies - It can be challenging to get health insurance coverage when you have a pre-existing health condition, but not all the health insurance companies are the same. There are insurance providers who take into consideration the entire medical history of the proposer when determining pre-existing health issues, and others will only take into consideration the medical history of the past few years.
2. Hiding a Pre-existing Illness - Refrain from hiding any health issue because if it is disclosed at the time of treatment, then the insurer can reject your health insurance claim.
3. Every Visit to the Doctor Does not Count - Health insurance companies will only take into consideration your health ailments that will have an impact in the long run. And if you are prone to flue, cough, colds, and fevers then do not fret! The insurance company will not consider short-term health issues as do not have long-term side-effects.
4. Pre-existing Diseases can be covered - It is not true that pre-existing illnesses are not covered by any health insurance provider. There is a waiting period for pre-existing diseases. During the waiting period, you will have to wait until the specified illnesses are given a cover. During the waiting period, your claim will be rejected for such specified diseases. And in some policies, the insurer does offer coverage to pre-existing illnesses that the policyholder might have.

During the waiting period, the insured doesn’t cover the doctor fees, cost of medicines and any hospitalization required for pre-existing ailments will not be covered by the policy. It will only be covered after the completion of the waiting period or will not be covered at all.  

5. Working around the Waiting Period - Whether you buy an individual health plan or a family health insurance plan, there is a specific waiting period that restricts you from filing a claim for a certain specific period.  This time duration of the waiting period may differ on the basis of the insurance provider and even your medical condition. It also depends on the duration and severity of your pre-existing disease.

Some health insurance plans will have a waiting of 2 years for the same disease and the other health insurer will have a waiting period of four years. It is suggested that you switch to a different insurance provider only after completing your waiting period; so that it is accrued when you switch the insurer and do not have to start afresh. Nonetheless, there are insurers that offer a reduction in the waiting period by paying an extra premium amount.

Additionally, some health insurance providers have a co-payment for pre-existing conditions. In this co-payment clause, you have to pay some percentage of the amount and the insurer will pay the outstanding amount.

So, even if you have a pre-existing health problem you can still get health insurance coverage. It is all about being informed and selecting the right health insurance policy.