Here’s All That You Need to Know About Pre-Existing Diseases In Health Insurance

It might be claimed that the average person’s health is declining because the average medical expense for an Indian resident is rising every year. We get health insurance to reduce the financial risk that comes with such problems.

A health insurance contract frequently has a number of clauses that we are unable to comprehend. One such provision relates to disorders that are already present. The IRDAI defines pre-existing disease as any condition, ailment, injury, or disease that was diagnosed by a doctor within 48 months of the policy’s effective date or its reinstatement, or for which medical advice or treatment was recommended by a doctor within 48 months of the policy’s effective date or upon its receipt from a doctor. Simply said, pre-existing conditions refer to any illness you are diagnosed with within two years of purchasing medical insurance. Visit the official website of IRDAI for further details.

What conditions are covered and not covered under the pre-existing conditions clause in health insurance?

Pre-existing conditions are typically included in health insurance policies for conditions like blood pressure, diabetes, thyroid, and cholesterol. It is crucial to realise that pre existing diseases do not include typical illnesses like fever, viral flu, cough, and colds, etc., which do not have the potential to worsen over time. Existing conditions are completely excluded from health insurance coverage. People frequently wonder whether all claims linked to pre-existing conditions are excluded from cashless health insurance coverage after learning what pre-existing conditions are covered by it. “NO” is the response to it.

After the waiting time has lapsed, health insurance providers honour claims relating to these disorders based on the health insurance premium calculator. During the waiting period, the insured cannot file claims for pre-existing conditions. This time frame typically ranges from two to four years, depending on the provider.

Considerations for pre-existing disorders

Detection of a pre-existing disease must first be explained to the potential policyholder so that he can analyse his health and determine if such diseases exist in him or not. When purchasing medical insurance, it is advised to choose a bigger sum covered to address pre-existing problems.

Full medical history disclosed

The insurance company might also inquire about any further medical conditions you may have; however, some just want to know about the most recent two to five years of your medical history. The policyholder has a responsibility to completely and truthfully disclose all relevant information.

Pre-insurance medical examination

You might need to have a medical examination to identify any pre-existing disorders, which can help your doctor assess your health. It is wise to select a policy with a shorter waiting time if you anticipate things getting worse soon. This is a subjective evaluation based on a person’s specific medical problems.

What occurs if I don’t reveal any existing medical conditions?

If the preexisting condition is not disclosed, the renewal of the policy may be denied or claims for such conditions may be dishonoured.

Existing medical conditions have any impact on the premium cost?

In general, pre-existing conditions result in higher insurance premiums because there is a larger likelihood that a claim will be made.

Questions and Answers:

  • Is it possible to shorten the waiting period for pre-existing conditions?

Yes, by paying a certain sum in addition to the premium payment, the waiting period can be shortened to one year.

  • Does prior illness influence the level of coverage?

No. Insurance coverage is a personal choice, and it does not have anything to do with pre-existing conditions.

  • What happens if I am aware of a condition that qualifies as a pre-existing illness but refuse to reveal it to the insurance provider?

The insurance company has the right to deny the claim if a pre-existing ailment was not disclosed.

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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.