Health insurance policy for pre-existing conditions can feel complicated, especially when illnesses like diabetes, asthma or hypertension are already part of your medical history. As per IRDAI guidelines, any condition diagnosed or treated within 48 months before buying a policy falls under this category. Most insurers do not offer instant coverage; they apply a waiting period before you can make related claims. Understanding these rules upfront helps you choose the right plan, avoid unpleasant surprises, and secure the protection you actually need. 

Keep reading to explore key guidelines and smart selection tips.

What is a Pre-existing Condition in a Health Insurance Plan?

A pre-existing condition in a health insurance plan is a medical condition, injury, or illness. This health condition existed before joining the insurance coverage. The pre-existing conditions are primarily asthma, diabetes, cancer, or high blood pressure. 

For instance, suppose an insured individual has high blood pressure and enrols in a plan. Then, that high blood pressure is a pre-existing condition. Regulators in India consider that such a disease can be diagnosed or treated for up to 48 months from the purchase of the policies. Insurers are thus allowed to impose a waiting time or special condition.

What is the Waiting Period for Pre-existing Diseases in Health Insurance?

The waiting period for pre-existing disease (PED) in health insurance varies from one insurer to another, generally 2 to 4 years. During this tenure, however, any claim relating to pre-existing conditions is not covered. After the waiting period, the policy includes these conditions. Thus, always make sure to check out the details of the waiting period in the policy to prevent harassment during the claim process. 

What is the Impact of a Pre-existing Disease on Your Health Insurance?

Let’s find out the impact of the presence of pre-existing disease on your health insurance plan:

1. If you already have a medical condition (e.g., diabetes, hypertension, or thyroid disease) before obtaining the policy, the insurer will consider you a risk.
2. During the waiting period (usually around 36 months), another pre-existing illness cannot be claimed for treatment.
3. Insurance premiums will probably be higher when you do declare a PED, since the insurance company believes that you can easily claim before the time.
4. When applying, if you are hiding the PED, it might get rejected during use. You should be honest in filling in your health history.
5. Upon expiry of the waiting period, the insurer covers the treatment of such a condition, subject to the conditions stipulated in the policy (and as long as it is reported).
6. Due to a PED, you may have to consider the option of increasing the amount insured for which you have opted for the policy. Otherwise, seek extensions/ riders that will shorten the waiting period.

How to Choose a Health Insurance Plan with Pre-existing Conditions?

Here are the key steps to follow while you choose a health insurance plan with pre-existing conditions:

• Verify the Waiting Period

Before most of the insurers in India can cover pre-existing diseases, they must cover it after a waiting period. The waiting period is usually 2-4 years. Select those plans that have the least waiting time.

• Opt Total Disclosure

When applying, always present your current situation truthfully. In the case you hide it, it might lead to a claim rejection later on.

• Consider Pre-existing Conditions in the Policy

There are policies where any illness diagnosed within 12 months before the date of the policy is pre-existing. There are policies with a 24- or 36-month period.

• Check the Sum Insured and Cover Option

Because treating pre-existing conditions may be more expensive in the long run, select a policy with a higher sum insured. Also, look for other benefits such as annual health examination, day-care treatments, domiciliary care, etc.

• Compare Premium Prices

A pre-existing condition may increase the premium. Explore among insurers and get competitive rates.

• Check Network Hospitals and Claim Settlement Ratio

In case of a pre-existing disease, you will benefit from an insurer with a large number of cashless hospitals as well as a good track record of claim settlement.

• Check the Exclusions

Despite the waiting period, insurance policies do not cover all conditions (or treat them differently) (e.g., organ transplants in relation to the underlying illness). Make sure to clear it.

These steps will help you be better positioned to choose a health insurance option that realistically meets your needs, even with a pre-existing condition.

Bottom Line

The existence of a pre-existing condition does not imply that an insured individual cannot have health insurance. Instead, it only means that you should be careful when reading the fine print. Watch out for the waiting period to the coverage date. Make sure you disclose all your medical conditions; anything hidden may result in a claim being rejected in the future. 

During your health insurance renewal, review your waiting period and the available coverage options for pre-existing conditions. On-time renewal ensures your health is safeguarded without interrupted benefits.