A detailed guide on health insurance related to Pre-existing Diseases

The Health Insurance Policies available in the market cover a broad spectrum of diseases, including pre-existing diseases, which refer to an underlying or asymptomatic ailment present in a person. 

What is a pre-existing disease or PEDs?

Pre-existing disease refers to the ailment one was suffering from before one purchased the policy. It is an ailment you were suffering from past 48 months or less before you bought the policy.  

Health Insurance for Pre-existing Conditions

The Insurance and Regulatory Authority of India (IRDAI), on 10th February 2020, has termed a pre-existing illness as a medical condition, sickness, disease, or injury that has been diagnosed in the insured person before the purchase of a Medical Insurance Plan. 

Any such medical condition diagnosed 48 months before the date of issuance will be considered a PED.

According to the new terms, only those diseases diagnosed before buying the policy will be considered PEDs. Some of the common PEDs are high blood pressure, thyroid imbalance, diabetes, cholesterol, etc.

Points to remember while buying a policy for Pre Existing Diseases

•  Do not hide your pre-existing ailment: It is important to share all details of your pre-existing ailment with your Insurance Provider, as non-disclosure of PEDs can lead to rejection of the claim in times of Medical Emergency and cause much trouble.
• Terms and conditions differ for PEDs under different policies: The list of PEDs, screening process, etc. may differ based on the policy. Several Insurers ask for medical screening of the client as well. Before zeroing in on a suitable Health Insurance Plan, one must carefully scrutinize the terms and conditions.
• Any Pre-existing disease must be disclosed: Many buyers feel disclosing PEDs after purchasing a policy will ensure lower premiums. However, one must not overlook the fact that the Insurer can cancel the policy at any time if there is a deliberate suppression of facts.
• Waiting Period for pre-existing conditions: The waiting period is when the policyholder has to wait for a particular period before he is eligible to make any claims from the Insurance Company. The waiting period usually ranges between 30 days to four years. The waiting period varies from Insurer to Insurer and from policy to policy.
• All plans do not cover pre-existing diseases: Study the terms and conditions of your Health Plan to ensure that Your Insurer covers PEDs. Then, select a suitable plan which caters to your PED needs.
• The waiting period can be waived off in certain cases: Some Insurers provide the option to waive off the waiting period or reduce the time upon payment of extra premium.
• PEDs can lead to higher premiums: An applicant with no pre-existing disease pays a lesser premium than those with a history of PED. However, the information about PEDs should never be held back in the lure of paying a lesser premium at present, as it may lead to claim rejection in times of Medical exigency and thus, prove counter-productive.
• Health Insurance may be denied on the basis of serious PED: The Insurance Company can deny you coverage if you have suffered from a heart attack, diabetes, cancer, etc.

Before purchasing a health insurance plan for PED, compare several plans and then select the best based on your individual needs.

Best 4 Health Insurance Plans for Pre-Existing Diseases in India

Mentioned below is a list of Health Insurance Companies which provide health cover for PEDs in India

1. Apollo Munich Energy Health Insurance Plan
2. Aditya Birla Activ Health Enhanced Plan
3. HDFC ERGO Energy Gold Health Insurance Plan
4. Star Health Diabetes Safe Health Insurance Plan

1. Apollo Munich Energy Health Insurance Plan

This Health Insurance Plan covers the policyholders from day one of the policies for pre-existing diseases. The policy is suitable for patients suffering from hypertension, type 1 type 2 diabetes, etc. It also provides cover for pre and post-hospitalization charges and provides cover for 144 Day Care procedures. Sum insured ranges from Rupees 2 lakh to rupees 50 lakh, and there is a no claim bonus benefit as well. There is no co-payment or waiting period clause. 

2. Aditya Birla Activ Health Enhanced Plan

This policy offers comprehensive health benefits that can be availed from the day of policy commencement. The policy includes hospitalization charges, health check-ups, transportation costs, and international coverage for critical illnesses. The sum insured ranges between Rs 2 lakhs to Rs 2 crores. The policy covers PEDs without co-payment or waiting period. Additional add ons can be purchased upon payment of a slightly higher premium.

3. HDFC ERGO Energy Gold Health Insurance Plan

This health plan has a network of 10,000 hospitals in India with a sum insured ranging between Rs 2 lakh to Rs 50 lakh. This plan covers pre-existing diseases and covers people who have diabetes, hypertension, etc. It also covers pre and post-hospitalization charges and provides free health monitoring of the policyholders. 

4. Star Health Diabetes Safe Health Insurance Plan

This plan covers diabetes patients and is available both as an individual cover and as a family floater option. Coverage can be availed from day one of the policy. In addition, the policy provides for surgery cost, OPD coverage, etc. The sum insured ranges between Rs 3 lakh to Rs 10 lakh.

In a Nutshell   

One must compare the numerous Health Plans available in the market and select the one best suited to one’s individual needs, pre-existing ailments. The chosen policy should provide sufficient cover so that you can simply focus on accessing the best possible treatment without worrying about the costs involved in times of medical need.