Pre-existing diseases are covered under a health insurance policy

Pre-existing diseases can be covered under a health insurance policy, but there are specific conditions and terms that vary depending on the insurance provider, the type of policy, and the waiting period. Here's a detailed breakdown of how pre-existing diseases are covered under health insurance policies in India:

Coverage of Pre-existing Diseases in Health Insurance:

1. Waiting Period for Pre-existing Diseases:

   • Most health insurance policies in India have a waiting period for covering pre-existing diseases. This means that any medical condition you were diagnosed with before purchasing the policy will not be covered during the waiting period.
   • Waiting Period Duration: Typically, the waiting period for pre-existing diseases ranges from 2 to 4 years. For example, if you have a condition like diabetes, you will not be able to claim benefits for diabetes-related treatment until the waiting period is over.

2. Post-Waiting Period Coverage:

   • Once the waiting period is over, the insurer will cover the treatment costs related to the pre-existing diseases under the policy, provided the condition is not excluded under the terms of the policy.
   • Example: If you have hypertension and after 3 years of waiting, your policy will start covering treatment related to hypertension, such as hospitalisation or doctor’s consultation, based on the plan's coverage.

3. Impact of the Waiting Period on Pre-existing Diseases:

   • During the waiting period, pre-existing diseases will be excluded from coverage. For instance, if you have a heart condition and require surgery within the first 2 years of purchasing the policy, that surgery will not be covered by the insurer. But after the waiting period is over, such conditions will be covered under the policy.

4. Critical Illness Policies and Pre-existing Diseases:

   • Critical illness plans may have shorter waiting periods (usually around 1 to 2 years) for pre-existing conditions, especially if the condition is one of the critical illnesses covered under the policy (e.g., heart attack, cancer). However, they may still exclude coverage for conditions that aren't classified as critical.

5. Exclusions for Specific Diseases:

   • Some insurers might exclude certain pre-existing diseases entirely from coverage. For example, psychiatric disorders, aids-related conditions, or other chronic conditions may not be covered, depending on the policy.

6. Disclosure of Pre-existing Diseases:

   • It is mandatory to disclose any pre-existing diseases when purchasing a health insurance policy. If you don’t disclose your pre-existing conditions at the time of application, the insurer can reject your claim later on, even if the condition was diagnosed after the policy was purchased.

7. Portability of Health Insurance and Pre-existing Diseases:

   • When you switch insurers (porting your policy), the new insurer may reduce the waiting period based on how much time you’ve already served under your previous policy. This can be beneficial if you have pre-existing conditions and are looking to get coverage for them earlier.

8. No Claim Bonus:

   • Some health insurance policies offer a No Claim Bonus (NCB), which is an additional sum insured for every claim-free year. This bonus does not usually affect the waiting period for pre-existing conditions but can increase the sum assured for future claims, making the coverage more comprehensive.

Example of Pre-existing Disease Coverage:

Let’s say you have diabetes and purchase a health insurance policy:

• If the insurer has a 3-year waiting period for diabetes, you will not be covered for any diabetes-related expenses (like hospitalization for diabetic complications) in the first 3 years.
• After the 3-year waiting period ends, the insurer will start covering diabetes-related medical treatments, as long as the policy doesn’t exclude it.

Conclusion:

• Pre-existing diseases are covered under most health insurance policies in India, but after a waiting period (typically 2-4 years).
• The coverage for pre-existing conditions becomes effective only after the waiting period expires, and the policyholder continues to pay premiums without interruption.
• Honesty in disclosure of pre-existing diseases is crucial to avoid claim rejections.
• Always read the policy terms and conditions to understand how your specific condition is covered and if there are any exclusions or restrictions.