Pre-Existing Diseases and Health Insurance: What to Expect?

What is Pre-Existing Illness in Health Insurance?

Pre-existing disease or illness in health insurance refers to illnesses or medical conditions that the policyholder has already been diagnosed with or received treatment for before purchasing a health insurance policy. Some of the common pre-existing illnesses in the health insurance include:

• Hypertension
• Diabetes
• Thyroid
• Cardiovascular problems
• Asthma
• Migraine (medically documented)
• Arthritis, etc.

Generally, insurance companies consider people with pre-existing health conditions in the high-risk category. That means the person is more likely to require frequent treatments, leading to frequent hospitalisation and claims related to the existing illness. Hence, most of the insurance companies have imposed certain months and years of waiting period before the cover kicks in. Insurance companies also charge higher premiums and exclude certain conditions from the scope of coverage. Hence, it is crucial to understand the concept of waiting period and how having a pre-existing illness impacts your health insurance coverage.

Understanding the Waiting Period in Health Insurance

Waiting period in health insurance refers to a specified time period during which the coverage is not applicable for the defined illness/disease/medical condition/ treatment. In health insurance, the waiting period is not just limited to pre-existing illnesses. There are different types of waiting periods applicable to various clauses. Understanding the waiting period can help you make a better choice while buying health insurance coverage.

There are now health insurance companies that offer zero waiting period benefits with the health insurance policy, wherein coverage can start from day one. However, these benefits come at an additional cost. You can explore various health insurance plans from different insurance companies on the Jio Insurance Broking platform to make the right buying decision. You can explore the benefits offered by a bouquet of insurers and customise the plans as per your health insurance needs.

Impact of Pre-Existing Illnesses on Health Insurance Coverage

Having pre-existing illnesses can have a huge impact on your health insurance coverage in many ways mentioned below:

Restrictions on Coverage

Some insurance companies may put a co-payment clause or sub-limits on the pre-existing illness coverage that kicks in after the completion of the waiting period.

For example, let’s assume Raji ( the one who has diabetes before purchasing the policy) has purchased an INR 10 lakhs cover. Now, the insurance company puts a 20% co-payment clause on pre-existing illness-related claims. Let’s say she gets admitted to the hospital for diabetes related complications (after completion of the waiting period) and her hospital bill comes up to INR 1,00,000. Now, she has to co-pay 20,000 as per the policy.

Waiting Period

One of the main impacts of having a pre-existing illness before buying a health insurance policy is that you need to complete the waiting period to start receiving the coverage benefits. The waiting period can generally range from 24 months to 48 months. It is always wise to go with the health insurance policy that comes with a shorter waiting period to reap the benefits in times of need.

For example, let’s say a policyholder has a cardiovascular problem diagnosed before the purchase of a policy, and the waiting period specified in the health insurance is 24 months. In this case, claims related to cardiovascular problems are honoured only after the completion of 24 months from the date of first issuance of the health insurance policy.

Increased Premium

If you opt for add-ons like a zero waiting period for pre-existing illness, then the premium you have to pay increases. You have to incur higher costs for getting your pre-existing illness covered from day one.

Coverage Exclusion

In certain cases, insurance companies may even completely exclude coverage for certain pre-existing conditions that may involve a potential high risk of claims in future. Some insurance companies may even deny health insurance coverage after medical underwriting, specifically for senior citizens and super senior citizens with more complicated health conditions.

Tips to Choose the Right Health Insurance with Pre-Existing Illness

Here are a few important tips to make a rational choice while buying health insurance with pre-existing illnesses:

1. Disclose all your health information honestly to the insurance company to avoid hassles and claim rejections in future.
2. Compare policies based on the duration of the waiting period, coverage limitations and exclusions to make an informed choice.
3. Health insurance policies are portable. Hence, whenever you find a better plan with suitable features, you can opt for porting or switching the insurance company at the time of the annual renewal process.
4. Ensure to read the fine print and all the clauses in your health insurance policy
5. You can also look for policies that offer stress management or wellness programs.

There are multiple policies which allow Day 1 cover for common illnesses like Asthma, High BP, High Cholesterol, Diabetes etc. at an additional premium, which should be available for hassle free coverage.

Other conditions can be covered with a 1 year waiting period at an extra premium.

Conclusion

To sum up, pre-existing medical conditions have a significant impact on your health insurance coverage. However, they are not the deal-breakers all the time. You need to have careful planning at the time of buying health insurance coverage with pre-existing illness. It is wise to buy health insurance early at a young age, maintain transparency in your disclosure and opt for higher coverage to ensure comprehensive protection.