Understanding Pre-existing Diseases: Their Impact on Health Insurance Coverage

Pre-existing diseases (PED)are medical issues you have before getting insurance. Insurers offer coverage options for individuals with pre-existing conditions, which can provide better financial protection and peace of mind. Unless the insurer excludes the medical condition you have, you can claim for expenses related to your pre-existing diseases. However, there are certain key clauses and conditions that you must be aware of. This blog sheds light on coverage of PEDs.

Common Examples of PEDs

Here are some common examples of pre-existing conditions (PEDs) that individuals may encounter:

• High blood pressure
• Alzheimer’s Disease
• Cancer
• Diabetes
• Thyroid disorders
• Asthma
• Obesity
• Sleep apnea
• Cardiovascular diseases
• Depression
• Bipolar disorder
• Chronic Obstructive Pulmonary Disease (COPD)

Importance of Declaring PEDs

Your doctor may have diagnosed that you have one of the above-listed PEDs.  Now, why declare PEDs when purchasing health insurance? Here are some reasons: 

• Smoother Claim Process: Being upfront about PEDs means quicker and smoother claim settlements.
• Fewer Claim Denials: There are high chances of claim rejection in case of non-disclosure. Hence, honest disclosure is essential to prevent denial of your claim.
• Policy Cancellation: While you might pay more premium for covering PEDs, it’s important to be honest about your health conditions, no matter how severe, to avoid complications that can even lead to your health policy being cancelled.

Pre-existing Diseases: Navigating Waiting Periods

Understanding the waiting period for Pre-Existing Diseases (PEDs) in health insurance is crucial. Here’s what you need to know:

• Coverage Delay: Health insurance plans usually don’t cover PEDs right away. There’s a waiting period before you can claim benefits for these conditions.
• Duration: The waiting period length differs depending on the insurer and policy. It can be anywhere from one to four years. During this time, you cannot claim your insurance for any medical expenses resulting from the PED.

Impact on Health Insurance Premium

Let’s explore how pre-existing conditions affect health insurance premiums:

• Higher Costs: People with pre-existing conditions usually pay more for health insurance. Insurers look at the risks these conditions bring and declare the premium accordingly. For instance, a person suffering from cardiovascular disease will have to pay a higher premium as compared to the one suffering from less serious conditions like diabetes.
• Loading: Insurers might add an extra charge, known as “loading,” to the premium. This is because pre-existing conditions make the insurance riskier. The amount of loading depends on how serious the condition is and the insurer’s rules.
• Renewal Benefits: If you keep renewing your policy every year without a break, some insurers might waive the loading for pre-existing conditions. This perk encourages people to keep their coverage going and get consistent benefits.

Pre-Policy Medical Check-Up

Before getting health insurance, those with pre-existing conditions (PEDs) might need a medical check-up. Here’s what happens:

• Check-up Requirement: If you have PEDs, the insurance company might request a recent check-up report before giving you a policy.
• Premium Impact: The results of this check-up can affect how much you pay for insurance.
• Possible Results: Depending on the check-up, the insurer might accept your application, refuse it, or offer reduced coverage.

What Happens When You Fail to Disclose PEDs?

If there is no medical checkup involved while buying insurance, you may be tempted to hide your PED diagnosis. However, this can hurt you when you make an insurance claim later for a disease associated with your PED. 

For example, if you have purchased a Rs.5 lakh insurance with a 3-year waiting period for PED. At the time of buying insurance, you have already been diagnosed with diabetes. However, as no health check-up was mandated, you chose to skip disclosing this diagnosis with your insurer. 

Now, after 6 months of buying medical insurance, you have an infected toe that needs to be removed due to your diabetes. You proceed with this surgery and assume the insurer will cover the cost. 

However, when you make a claim for any medical expense, the insurer will review the hospital records. They would discover quickly that you had diabetes at the time of buying insurance, and you failed to disclose it. 

As a result, the insurer will not only deny the claim, but they may also cancel the policy, making you forgo all types of health insurance benefits. So, always be upfront about your diagnoses and disclose PEDs to get the coverage you deserve. 

Key Takeaways

Dealing with health insurance and pre-existing conditions can be tricky. But it’s crucial to be upfront about your health history. Being honest helps speed up claim processes and lowers the chances of problems later. Sure, you might pay more for covering pre-existing conditions, and there might be a waiting period, but it’s worth it to have better coverage that fits your needs. So, stay informed and don’t hesitate to ask questions when getting health insurance.

Additionally, consider choosing platforms like PhonePe for a seamless and hassle-free insurance purchase experience.