Is my pre-existing illness covered in my Health Insurance ?

The most common doubt that arises among people is whether their pre-existing conditions would be covered in the policy plan or not? Health insurance plans come with certain restrictions and regulations. Going through your policy plan and clear communication with the insurer would surely clear your puzzled mind!

What Is a pre-existing illness?

Any health problem such as Asthma, Heart disease, Cancer, Diabetes, etc., that the insured is suffering from before issuance of health coverage is considered to be a pre-existing illness or condition.

• The condition is most of the time known to the insured
• Such kind of conditions can range from the level of seriousness and are usually long-term

To be more specific, The Insurance Regulatory & Development Authority of India (IRDAI) says that if you suffer from any condition, illness, disease, or ailment which was diagnosed or for which medical advice or treatment was recommended by, or received from, a physician within 48 months before the effective date of the policy issued by the insurer or its reinstatement is considered as a pre-existing illness.

Your pre-existing illness will not be covered right away

If you are suffering from any pre-existing illness, your insurance policy will not cover it right away after the effective date of the policy.

Once your policy comes into effect, there is a certain waiting period for the coverage of your pre-existing disease. This waiting period can vary from 2-4 years, depending upon the illness and terms of the company. While your other acute health conditions can be covered after about 30 days of your policy purchasing (the period varies from company to company)

Why is there a waiting period?

It might seem weird that even after your policy purchase and regular payment of premiums, you still have a long way to go for coverage. However, there is a simple explanation behind it. Your insurance policy will cover your other health conditions or emergency injuries except for your pre-existing illness in the beginning. This is because the insurance companies can't afford to go through such a high financial risk for such long-term diseases. But no matter what, the sun shall rise much brighter one day. Soon, your pre-existing illness will also have a place in the heart of your policy claim!

This is the reason why you should always apply for health insurance at an early stage. We feel happy to reach school or office on time by waking up early. Similarly, as early as you apply for your policy, you will get the desired benefits at the right time in the future!

However, you are always open to researching thoroughly and choosing the most suitable plan with a low waiting period at an affordable cost. A low waiting period might also mean paying a higher premium. Along with this, make sure you go through policy exclusions or the diseases for which coverage is excluded from your policy.

But I did not disclose my hypertension……..

What if you did not disclose your pre-existing medical condition at the time of applying for the policy? Well, in that case, you can't blame the insurance company for not providing you with a claim for it. Therefore, always make sure that you are transparent about your medical record at the time of policy purchase so that you get a smooth claim without any obstacles.

The scenario is much better now!

The rates of claim rejection were increasing before IRDAI introduced an amendment in the coverage of pre-existing conditions in 2020. While earlier, any disease which was diagnosed within 3 months from the effective date of policy was considered as a pre-existing illness. This means that the coverage for such diseases was provided after the waiting period.

But now, since the clause has been removed, it will be beneficial for policyholders as the claim rejection rates have been reduced. Also, the insured makes sure that he/she discloses all the medical information honestly during policy purchase.

Make sure that you go through the terms & conditions of the insurance company, regarding the coverage of pre-existing diseases, while applying for your health insurance to avoid issues in the future.

What can we do?

ClaimTherapist can help you in decoding your policy. We can help you in understanding your policies better and providing you claim assistance. Contact our expert today and let them handle the rest!