How do pre existing diseases affect health insurance plans?

Sonika’s father had been a diabetic for some time now. Concerned about his medical condition, she approached an insurer to buy a health insurance plan suitable for him. However, what followed was something Sonika hadn’t imagined. She was informed that since diabetes is categorized as a pre-existing disease, any complication arising due to it would not be covered for upto three to four consecutive years by most health insurance plans.

In the last year itself, the prevalence of lifestyle diseases such as high blood pressure, diabetes, cholesterol and thyroid has increased among individuals below the age of 45 in India. While only 30 percent of 20 to 30-year-olds reported some kind of medical issue, the figure rose to 48 percent in those aged 31 to 45 years and was the highest at 74.6 percent in those above the age of 60.

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As the name implies, a pre-existing disease is a term used by insurers to refer to a medical condition that an individual might be suffering from, before purchasing a health insurance policy.  This could refer not only to the history of your condition in case of heart disease, diabetes etc, but also hospitalisation due to kidney stone, angioplasty or a major accidental injury. Any signs or symptoms relevant to a condition such as rise in sugar levels, weight gain or loss as well as any medication that you are taking, needs to be declared, before you buy a health insurance plan.

Pre-existing diseases can make the process of buying health insurance plans challenging. Here are a few ways they can impact your health insurance policy:

1. Higher premiums: The healthier you are, the less risk you pose to the insurer. An individual with pre-existing medical conditions would have higher chances of claims in the future as compared to a normal healthy person of the same age and hence will be charged a higher premium. This is called premium loading.

2. Waiting period: No coverage is offered for pre-existing diseases for two to four years from the time you buy a health insurance plan. This may vary from one insurance provider to another and also on the severity of your condition and is called waiting period. It is only after the completion of the waiting period and the renewal of the policy, that you can file a claim that arises out of treatment for your medical condition.

3. Higher premiums and longer waiting period: It may be a double whammy if your existing condition is more chronic and severe. Not only would you need to pay a higher premium as compared to a healthy person of similar age, but also wait for a longer period after which your expenses will be covered by your policy.

4. No coverage: In cases where the chances of a relapse due to a medical condition are high, the insurer might agree to provide cover by completely excluding your pre-existing disease. This not only increases your risk, but also expenditure.

5. Policy denial: Those suffering from a chronic medical condition with a long history such as diabetes, heart attacks might have high chances of refusal by the insurance company to issue a policy. A medical check-up is done prior to issuing a policy and the insurance provider has the right to deny a policy to an individual based on the results.

It is important to clearly state any pre-existing diseases that you might have right at the onset of buying health insurance plans. Hiding your condition might only have serious repercussions for you later. You might be left in the lurch, when you file a claim that is denied by your insurance provider, on the grounds that no such declaration was made by you at the time of policy purchase. The company can also terminate the policy without refunding the premiums paid by you.

It helps to compare health insurance plans for their terms and conditions specifically for pre-existing medical conditions and make an informed decision on the premium amount and how long would you want to wait to be insured. For instance, Bajaj Allianz Health Insurance available on Finserv MARKETS offers a waiting period of three years for pre-existing diseases disclosed at the time of purchasing the policy, provided the insured pays premiums regularly till that time. There are different plans available to suit different needs with cashless treatment available at more than 6500 hospitals all over India. So choose the right plan for you and your family and protect their future.


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