Effects of Pre-existing Diseases on Your Health Insurance

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Effects of pre-existing diseases on your health insurance

An illness or condition is considered to be pre-existing if a doctor diagnosed it at least 48 months before the date the health insurance policy was issued. Pre-existing conditions, which typically refer to chronic illnesses like diabetes, hypertension, heart disorders, etc, will not be covered under this category. This includes general fever and colds. Following a medical evaluation and a brief waiting period, the insurance company will approve the insurance request.

How do Pre-Existing Diseases Affect Health Insurance?

1) Waiting Period For The Insurance

A waiting period may be required by some insurance companies before they agree to cover pre-existing conditions at the standard premium rate without increasing the cost. This waiting period varies across various insurance companies and might last anywhere between two and four years. The insurance plan will pay hospitalization expenses or hospital bills for the pre-existing conditions throughout this waiting time.

2) Premium Loading

This indicates that the premium will be on the higher side. Because the insurance provider is taking a chance by covering a pre-existing condition, the premium will be burdened. Only at the moment, the policy is purchased is this premium loading applicable. If the insurance is continuously renewed without a break in between, it cannot be charged once more.

3) Impose Permanent Exclusions

When someone was diagnosed with a pre-existing condition in the past, it had a significant impact on their health, and many insurers would completely deny the entire coverage to avoid taking a chance. However, the most recent IRDAI guidelines permit insurers to impose a permanent exclusion if a pre-existing condition has a significant long-term impact on the covered person’s health. In this case, the insurer may offer you health coverage but permanently exclude that disease if they believe they cannot afford to accept the risk given your pre-existing condition. This means that, except for the pre-existing ailment, you may file claims for all other illnesses and injuries.

4) Impose Restrictions

If you file a claim linked to a pre-existing condition, the majority of insurers have the right to impose limits such as an increased premium. This means that you will be responsible for covering a set amount of costs for the care of your current illness. The remaining portion of the costs will be covered by your insurance.

As an illustration, suppose your policy has a copayment clause of 10%, you are hospitalized to treat a pre-existing condition, and the hospital cost is INR 10 Lakhs. You would then be responsible for paying 10% of the total bill, or INR 1 lakh, out of your pocket. And the insurance company will cover the balance.

5) Reject The Policy

If you have a pre-existing ailment, the insurance company may decide not to provide you with insurance coverage. They’ll turn down your request for a health insurance policy if this is the case.

Things You Should Know About Pre-Existing Diseases

Here are some crucial details about pre-existing conditions and health insurance that you need to be aware of.

1) Different Insurers Have Different Policies

When it comes to pre-existing sickness insurance, not all firms adhere to the same regulations. There is no optimum pre-existing condition medical insurance. A pre-existing condition might be covered by some insurers while it might not. Some might have a shorter waiting period, but others might have a longer one. Therefore, before purchasing the plan, carefully read the terms and conditions.

2) Every Doctor Visit Is Not Counted

You don’t need to be concerned about sharing ailments like the typical cold or cough. It’s not a problem to see a doctor get rid of your headache. However, if the headache has lasted for a year and you are taking medicine, it may qualify as a pre-existing condition.

3) Hiding Pre-Existence Diseases

It is advisable to be open and truthful with the insurance provider about any pre-existing conditions to prevent complications when settling claims.

4) Pre-Existing Diseases Can Be Covered

The waiting period provision may apply to certain pre-existing conditions. Therefore, there is no rule prohibiting the coverage of pre-existing conditions.

5) Waiting Period Can Be Reduced

Similar coverage may be available from various insurance companies with a shorter waiting period. They could do that in exchange for a larger fee.

Do’s And Dont’s In Case Of Pre-Existing Diseases

1) Do Share Information About Pre-Existing Diseases With The Insurer

The simplest thing you can do to ensure you receive a great deal of flexibility is to disclose your pre-existing medical condition when purchasing insurance. This will guarantee that you are aware of the rules and regulations. It provides you the option of accepting or rejecting those terms and conditions.

2) Do Get A Voluntary Health Check-Up Done

This is a pretty typical complaint that people have when purchasing a policy. There are, of course, terrible consequences. Due to the nature of your sickness and the medical history that your doctor records, there is a very high likelihood that the insurance company may learn about your pre-existing disease at the time you file a claim. The employer then has full authority to reject the claim, whether it is for a related or unrelated illness, like in the situation we stated before.

If you hide your pre-existing condition, an insurance provider may terminate or cancel your policy arrangement with them permanently, which is a more serious result. without giving you your premium back.


Avoid hiding any illnesses and make them known up front when purchasing the policy to guarantee that your health insurance provides you with enough coverage. You can then be sure that all of your future claims will be settled legally.