Understanding Pre-Existing Conditions in Health Insurance
When you buy a health insurance policy, you might think that you are protected from all diseases and that every treatment is included in your medical insurance plan. However, all medical insurance plans have a pre-existing condition clause that requires the policyholder to wait a certain period of time before coverage can take effect. This clause is introduced to ensure that health insurance providers do not lose client commitment, and people do not misuse health insurance policies.
This blog examines the impact of pre-existing diseases on health insurance, key factors to consider when purchasing a plan, and how ManipalCigna addresses these concerns with dedicated solutions.
What is Health Insurance for Pre-Existing Conditions?
PEDs or Pre-Existing Diseases refer to medical illnesses or health issues that an individual already suffers from before applying for a health insurance plan. Some of the most common examples include high blood pressure or diabetes, as well as chronic diseases such as arthritis or thyroid disorders. The waiting period can be from 24 to 48 months, depending on the severity of the physical condition and the risk you face due to the PED.When you apply for insurance, it is the responsibility of your health insurance provider to carefully evaluate your medical history and understand the level of risk. Based on the assessment, the insurer offers the premium, coverage, and waiting periods. There is a common misconception that PEDs make you ineligible for health insurance. This is partially incorrect because you need to ensure that all the information is properly disclosed to the insurer while purchasing the insurance policy.
List of Pre-Existing Diseases Covered Under Health Insurance
Here are some of the most common pre-existing conditions that can be covered in your health insurance plan:
Diabetes and hypertension
Thyroid disorders
Asthma and respiratory issues
High cholesterol and obesity-related ailments
Certain cardiac conditions
It’s essential to note that coverage is typically extended after the completion of a waiting period, which can range from 24 to 48 months, depending on the insurer. Some policies may also permanently exclude specific diseases, so reading the fine print is crucial. The good news is that more insurers today are expanding their policies to cover lifestyle diseases, making health insurance more inclusive.
Factors to Consider When Buying Health Insurance for Pre-Existing Conditions
It is crucial to understand your insurance plan and explore waivers or add-ons that may reduce the waiting period. Here are some of the most important factors to consider if you are buying health insurance with pre-existing conditions:
Premium Cost: If you have any pre-existing conditions, the insurer will consider you a high-risk case; therefore, the premium amount may be higher.
Waiting Period: A few plans have a waiting period ranging from 24 to 48 months; however, this period can be shorter in some cases
Disclosure: Always disclose all the information about your medical history to the insurance company to avoid any possible claim rejections later.
Sub-Limits and Co-Pay: Check if there are restrictions on coverage amount or mandatory co-payments for PED-related treatments.
Effects of Pre-Existing Diseases on Your Health Insurance
There are several factors should be considered when purchasing health insurance with pre-existing conditions. First, your premium will be higher than usual. So, if your friend is paying a lower amount (with a clean medical history), be prepared to pay a few extra rupees when buying a health insurance plan.
Additionally, you may face longer waiting periods before the coverage takes effect. There may be a few surgeries and treatments that are not initially covered. Despite these challenges, the long-term benefit of being insured outweighs the limitations. With the right plan, you can reduce financial stress during medical emergencies.
Types of Waiting Periods in Health Insurance
You should be aware of the types of waiting periods associated with health insurance. Some of the most common waiting periods include:
| Type of Waiting Period | Description |
| Initial Waiting Period | It is generally 30 days from the policy start date, applicable to most illnesses except accidents, and might be waived in a few plans. |
| Specific Disease Waiting Period | A few medical conditions, such as a hernia or cataract, may have a fixed waiting period of 1 to 2 years. |
| Pre-Existing Disease Waiting Period | It can range from 24 to 48 months, depending on the severity of the issue. |
Dos and Don’ts in Case of Pre-Existing Diseases
Here are the Do’s:
- Always disclose your medical history.
- Always keep medical records updated.
Don’ts:
- Never conceal your medical history or falsify medical records.
- Never ignore any add-ons that can enhance PED coverage.
What Should You Do When Buying Pre-Existing Condition Health Insurance?
For individuals with pre-existing conditions, here’s a checklist before purchasing insurance:
Compare policies across insurers for PED benefits.
Look for plans with shorter PED waiting periods.
Consider adding options like critical illness coverage or disease-specific riders.
Check the insurer’s claim settlement ratio for reliability.
Assess network hospitals to ensure cashless treatment availability.
Secure your Future Today with ManipalCigna Health Insurance
ManipalCigna Health Insurance offers products designed to address the needs of people with pre-existing conditions. These plans offer broader coverage, customised waiting periods, and adaptable benefits for policyholders.
ManipalCigna Sarvah Pratham and Uttam
These plans are designed for individuals seeking comprehensive coverage that includes coverage for common pre-existing conditions. They provide affordable premiums and practical waiting period clauses, making them suitable for middle-class families managing chronic illnesses.
ManipalCigna Sarvah Param
This plan is ideal for customers seeking comprehensive benefits and higher coverage. It encompasses a broader range of PEDs and is designed to strike a balance between affordability and premium healthcare protection.
Conclusion
Pre-existing conditions may add complexity to the process of buying health insurance, but they don’t have to be a barrier. By comparing plans, understanding waiting periods, and choosing insurers that are transparent and inclusive, individuals can secure effective coverage. With the right health insurance plan, pre-existing conditions can be managed without financial strain, ensuring peace of mind for you and your family.
FAQs About Pre-Existing Conditions in Health Insurance
How are pre-existing conditions determined?
They are identified through medical history, health check-ups, and disclosures made at the time of insurance application.
Does a pre-existing illness have any impact on the premium?
Yes, insurers usually charge higher premiums as the risk of claims increases with PEDs.
What are pre-existing diseases (PED) in health insurance?
These are health issues or illnesses diagnosed before purchasing a policy, such as diabetes or hypertension.
What is the waiting period for pre-existing diseases?
The waiting period typically ranges from 24 to 48 months, depending on the insurer and plan chosen.
Can I be denied health insurance because of a pre-existing condition?
In rare cases, yes. However, most insurers now offer PED coverage with certain conditions applied.
What is a pre-existing disease before 48 months?
Any condition diagnosed within 48 months prior to applying for insurance is classified as pre-existing.
What is a severe pre-existing condition?
Conditions like cancer or advanced cardiac issues that involve high treatment costs and risks are termed severe.
