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Pre-Existing Disease List
Mar 30, 2021

Pre-Existing Diseases List In Health Insurance Policies

Due to certain factors, from family medical history to lifestyle changes, some ailments have given rise. Nowadays, having health insurance is a necessity and a much-needed financial backup plan for medical emergencies. Pre-existing disease is a medical condition that already exists when one is purchasing a health insurance policy. Medical conditions such as high blood pressure, diabetes, thyroid, asthma, depression, etc., are considered pre existing ailments. Major health insurance policy companies do not cover any pre-existing ailments when buying a new health insurance policy. Because people who have pre-existing diseases often have to undergo several procedures. Thus it is imposed a higher financial risk to the insurers. One needs to look at particular policies, to cover pre existing diseases in health insurance. Mrs. Bhatt purchased a health insurance policy of INR 5 lakhs. Upon filling up the form about any pre-existing ailments, she didn’t disclose her asthma problem because she was afraid to pay more premiums. She didn’t even check for other health insurance policies that have pre existing disease lists covered. After a year of buying a health insurance policy, Mrs. Bhatt was admitted to the hospital due to her breathing problem. At the time of the hospital bill settlement, her health insurance company rejected her claim because it doesn't cover any pre-existing ailments. Her report says she has asthma for the past five years. Many people like Mrs. Bhatt hide their pre-existing diseases while buying a health insurance policy and get rejected while claiming. It is essential to know which health insurance you need to buy if you have any diseases and check the pre existing disease list in health insurance policy with the terms and conditions.

What is the pre-existing diseases list in health insurance?

Different health insurance providers have various waiting periods for pre existing disease lists. Some insurers have a two years waiting period, while some have around four years. During the waiting period, the policyholder needs to wait until the specified ailments are given a cover. Until then, if the policyholder applies for a claim, it will be rejected. It will only cover once the waiting period is over. To make health insurance accessible to all the people, including those who have pre-existing diseases when opting for the health insurance policy, in October 2020, IRDAI (Insurance Regulator and Development Authority of India) made some amendments to the definition of pre-existing diseases.
  • Several diseases, such as mental illness, illness due to hazardous activities (for people who work in factory machines), genetic disorders, menopause, etc., were earlier not covered in health insurance policies and are now covered.
  • Any diseases diagnosed by a doctor four years before the health insurance policy’s issuance will come under pre-existing conditions.
  • The health insurance company needs to settle or reject the claim within 30 days of the period from the date it's received.
  • An insurance company cannot reject the claim after the policyholder pays the premium for eight years.
This amendment has reduced the claim rejection among many policyholders. Additionally, some health insurance companies have co-payment facilities for pre-existing health conditions. In a co-payment facility, the policyholder needs to pay some percentage of the amount, and the health insurance company will pay the balance amount.

Below are some frequently asked questions asked by a policyholder about pre existing disease list in health insurance policy:

  1. What things to recognize while you have a pre-existing health condition while buying health insurance in India?
  • Identify the ailments you have: not every condition is considered a pre-existing disease. Ailments such as diabetes, thyroid, weak heart, asthma, high blood pressure, etc., can be regarded as pre-existing diseases.
  • Fill up every detail regarding pre-existing diseases: do not hide anything, or else it may lead to the claim rejection in the future.
  • Consider check-up before buying a health insurance policy: in many cases of pre-existing disease, health insurance service providers may ask to submit the complete medical check-up before purchasing a health insurance policy.
  • Check on waiting period: some insurers have two years waiting periods while some have a longer one. Few health insurance companies may have a low waiting period to cover the policyholder's pre-existing health condition.
  • Premium: due to the health insurance company covering the policyholder's pre-existing diseases; the premium amount will be on the higher side.
  1. Will there be any impact on the coverage amount if one purchases a pre-existing health insurance policy?
No. There is no impact on the coverage amount. However, there will be a certain waiting period that the policyholder needs to wait before claiming.

Final Thoughts

Every health insurance policy differs from one another. Thus one needs to check with its terms and conditions of pre-existing diseases list and the waiting period. Ailments such as cough, cold, fever, or other minor diseases are not covered in health insurance. Consider purchasing a family health insurance plan covering pre-existing diseases if you are opting for senior parents. Silver Health Insurance Plan by Bajaj Allianz is specially designed for people between 46 and 70 and covers pre-existing diseases from the second year of the policy.   *Standard T&C apply 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.

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