Health insurance for pre-existing medical conditions in India


Jul 05 2023


A healthy lifestyle can include a healthy diet, abstaining from bad habits, having a healthy daily routine, exercise, work-life balance, stress management, etc. However, many people find it challenging to follow a healthy lifestyle due to a lack of time, knowledge, other commitments, etc. As a result, there is a probability of falling ill. Fortunately, we have health insurance plans that cover pre-existing diseases and also guide people on how to maintain a healthy lifestyle, thereby either reversing the disease or keeping it in check. Let us understand what a pre-existing disease is, how to get health insurance for it, and how to reverse/manage the disease with a healthy lifestyle.

What are pre-existing conditions?

A pre-existing disease means any condition, ailment, injury or disease that has been diagnosed within 48 months prior to the issue of a health insurance policy or its reinstatement. For example, if an individual is already suffering from diabetes at the time of purchasing a health insurance policy, it will be categorised as a pre-existing disease. Some other examples of pre-existing conditions can include hypertension, obesity, asthma, etc. if the individual is suffering from any of these at the time of purchasing health insurance.

Pre-existing disease health insurance

Usually, there is a waiting period of 24 to 48 months before the treatment for a pre-existing disease can be covered under a health insurance policy. The waiting period for pre-existing diseases may vary across:

a) Different plans of the same health insurance company

b) Different variants of the same health insurance plan

For example, the ManipalCigna ProHealth Prime Insurance Plan is offered in 3 different variants:

a) ProHealth Prime Protect

b) ProHealth Prime Advantage and

c) ProHealth Prime Active

Under the ProHealth Prime Active variant, the waiting period for specified pre-existing diseases is only 90 days. These specified pre-existing diseases include:

a) Asthma

b) Diabetes

c) Obesity

d) Hypertension and

e) Dyslipidaemia

Apart from the above-specified pre-existing diseases, the waiting period is 24 months for covering any other pre-existing disease(s).

If the insured person enhances the sum assured, the waiting period will apply afresh for the enhanced part of the sum assured. If the insured decides to port into this policy, the waiting period will be reduced for the prior coverage period. The prior coverage should be continuous without any break as defined under the IRDAI's portability norms. The insured must declare the pre-existing disease at the time of applying for health insurance.

Wellness Program

The ManipalCigna ProHealth Prime Insurance Plan (Active variant) offers more benefits along with covering the specified pre-existing diseases after 90 days. It encourages you to adopt a healthy lifestyle and gives rewards based on the improvement in the health condition through the Wellness Program. The insured can participate in the Wellness Program in the following scenarios:

a) The insured is suffering from one or more of the following conditions: Asthma, Diabetes, Hypertension, Dyslipidaemia, Obesity

b) The condition has been either declared at the time of buying the policy or has been diagnosed subsequently in any policy year.

The insured can benefit by adhering to the Wellness Program metrics and earning rewards.

How to earn rewards?

The insured can earn rewards through the Wellness Program as follows:

1) Health risk assessment: Insured opts to participate in the Wellness Program by undergoing a health risk assessment. Based on the pre-existing disease(s), specified medical tests will be conducted at the beginning of the program in the policy year. The results of these tests will serve as the baseline assessment.

2) Coaching by experts: The insured will be coached by experts throughout the policy year. The coaching may include lifestyle improvement measures like a healthy diet, exercise, quitting bad habits, healthy daily routine, work-life balance, stress management, etc.

3) Improvement assessment: At the end of the policy year, the insured will undergo an improvement assessment. The medical tests done at the start of the policy year will be repeated. The improvement assessment results at the end of the year will be compared with the health risk assessment results at the start of the year.

4) Health score: The insured will be given a health score based on the health improvement parameters (as per medical test results). The health score will be for every specified health condition if the insured suffers from multiple health conditions.

5) Rewards: The weighted health score will be used for calculating the rewards. The reward points earned in a policy year can be redeemed against the renewal premium for the subsequent year. The reward points cannot be carried forward. Each reward point is valued at Re. 1. The maximum reward points that can be earned in a policy year will be limited to 15% of the premium.

Thus, the ManipalCigna ProHealth Prime Insurance Plan (Active variant) provides you with the following three features for pre-existing diseases:

1) A low waiting period of 90 days for covering specified pre-existing diseases (asthma, diabetes, obesity, hypertension and dyslipidaemia).

2) Managing or reversing the existing condition with the Wellness Program (coaching by experts)

3) Earning reward points based on health improvements and redeeming them for discount in renewal premium

Pre-existing disease: What to keep in mind for health insurance?

In the case of pre-existing conditions, you should always disclose it while applying for health insurance. If you don't disclose it and the health insurance company finds out later, your claim will be rejected, and the policy will be declared null and void.

When you apply for health insurance and declare a pre-existing health condition, the insurance company will ask you to undergo a medical test. Depending on the test result and the stage/severity of the disease, there can be various scenarios. The health insurance company may take one of the following decisions:

a) Accept the application as it is without any additional premium

b) Accept the application with a specific waiting period and with/without additional premium

c) Accept the application and make the pre-existing condition a permanent exclusion

d) Reject the application mentioning the pre-existing condition cannot be covered

e) Reject the application now and ask the individual to apply again after a specific time period

In most cases, the application will get accepted with a specific waiting period and with/without an additional premium.

Due to a sedentary lifestyle, work-life imbalance, bad habits, unhealthy diet, etc., diseases are rising. However, ManipalCigna Health Insurance has the right health insurance plans that not only cover pre-existing diseases with a low waiting period but also help you manage/reverse them.