April 22, 2024

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How Are Pre-Existing Medical Conditions Covered Under Your Health Insurance Policy

Health Insurance Policy


The benefits of health insurance are numerous. It offers you financial protection against unforeseen circumstances and medical emergencies. Health insurance has a number of advantages, but it also comes with limitations. One of these is the pre-existing condition coverage.

Many individuals believe that pre-existing conditions are not covered by health insurance, however this is not true at all.

Previous definition for pre-existing diseases (PEDs)

PEDs were earlier defined as chronic conditions, such as high blood pressure, cancer, diabetes, etc., that a person had at the time of purchasing health insurance or whose symptoms start to show three months after the date of issuance. Therefore, the insurance policy did not cover these ailments, and the policyholder could not use the insurance until the predetermined waiting. 

What Is Pre-Existing Diseases Health Insurance, New Definition?

The new definition of PEDs has now established itself as a game-changer. The Insurance Regulatory and Development Authority of India (IRDAI) defined a pre-existing illness as a medical condition, ailment, disease, or injury that the insured individual had before purchasing a medical insurance plan according to a circular issued by IRDAI on February 10, 2020. Any such medical issue that was found by a doctor 48 months prior to the policy’s issue or reinstatement date is considered as a pre-existing condition. Visit the official website of IRDAI for further details.

Only conditions that are common and were identified before to the purchase of insurance are now regarded as PEDs. As a result, if you had a condition before the insurance took effect but were ignorant of it or it had not yet been identified, PED would not cover it.

When purchasing a health insurance covering pre existing conditions, keep the following in mind.

  1. You must always report any existing medical conditions – Hiding facts or giving the insurance company false information will simply make matters more difficult for you. Insurance companies maintain the right to deny your claim and terminate your policy if a pre-existing ailment is not disclosed.
  1. You should declare any pre-existing conditions before buying a health insurance policy – Many consumers believe that declaring a pre-existing condition after buying a medical insurance plan will result in a more cost-effective premium and enable them to save more money.* However, the insurance company has the right to cancel your coverage at any moment if you are proven to have lied on purpose in your policy document.

*All savings are provided by the insurer as per the IRDAI approved insurance plan. Standard T&C apply

  1. There is a waiting period for conditions that already exist – The fundamental idea behind the waiting period is that you cannot use health insurance right away after purchasing a coverage. A policyholder may need to wait for a time frame that ranges from 30 days to 4 years. The initial waiting period, which is the same for all kinds of health insurance policies, is the first 30 days following the purchase of a healthcare plan. During this initial waiting period, no insurance claims can be made for any type of therapy. After the waiting period has passed, a medical insurance plan will cover pre-existing conditions.

What Should You Do When Purchasing Health Insurance for a Pre-Existing Disease?

You should constantly evaluate a number of policies and choose a medical insurance plan that is appropriate for your particular needs, age, financial situation, and medical issues because the rules, terms, and conditions for various health insurers can vary. 

In conclusion

One of the most important financial tools you should think about investing in for a safe financial future is health insurance. The features and coverage of your insurance plan, however, have a significant impact on its credibility.

Therefore, be careful to choose a plan that meets your needs and includes coverage for a variety of pre-existing conditions, so you never have to worry about money and can get the greatest medical treatment when you need it.

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Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms, and conditions, please read the sales brochure/policy wording carefully before concluding a sale.