/podcast/financial-vaccination
Hear our podcasts at every step of the way to live a better life.
Medical Insurance and the Curious Case of Pre-Existing Health Conditions
Medical insurance is not always as complex as it appears. You pay a premium, and the insurer reimburses your hospital bills in the event of something going wrong. The truth is more complicated, particularly where underlying health conditions come into play. These circumstances affect the premiums, waiting period, choices of cover, and even the approval of claims.
To a large number of policyholders, the puzzle begins with the proposal stage. Inquiries regarding previous sickness, drugs, and diagnosis can be intrusive. However, such details are the foundation of how health insurance operates. Knowing this relationship will allow you to make the right decisions, tell the truth, and not face any unpleasant surprises in the future.
A pre-existing condition is any illness, injury, or medical condition which was in existence prior to you taking out a health insurance policy. It can be diagnosed, treated, or simply symptomatic prior to the policy commencement date.
Such circumstances are not uncommon. This category can include lifestyle disorders, chronic illnesses, and even minor problems that keep recurring. Such conditions are evaluated by the insurers with some caution since they directly influence the occurrence of subsequent claims.
There are several sources that insurers use to know about your medical history. It is a process that is well organised and detailed.
Common methods used by insurers:
A simple table helps clarify this further:
Source of Information
Purpose
Proposal form
Primary declaration of health status
Medical tests
Validation of current health
Doctor reports
Risk assessment
Past policy data
Pattern of previous claims
Insurers do not want to refuse coverage. They are interested in pricing the risk appropriately and putting in place the right terms.
Pre-existing diseases cannot be excluded by default in health insurance. Such conditions are mentioned in most of the modern policies, with certain rules added to them.
The coverage is designed in such a manner that it allocates the risks between the insurer and the policyholder.
Once the waiting period for a pre-existing condition is completed, the policy begins to cover expenses related to that condition like any other illness.
Coverage typically includes:
After the waiting period, the condition is no longer treated differently under most comprehensive plans.
Coverage for pre-existing conditions comes with boundaries, especially in the initial years.
Common limitations include:
These conditions are clearly mentioned in the policy wording. Reading them carefully helps avoid assumptions.
Pre-existing conditions vary widely, from lifestyle-related issues to long-term chronic illnesses.
Common examples include:
Some conditions may feel minor, but still qualify if they existed before policy purchase.
Coverage for pre-existing conditions provides financial security. It protects you from the possibly high costs linked to ongoing medical treatments.
Health insurance for pre-existing conditions allows you to use a variety of medical services. This can include doctor visits, medications, and necessary procedures.
Having coverage for your pre-existing conditions brings peace of mind. You can focus on your health and not worry about the treatment expenses.
Medical inflation continues to rise year after year. Treatments that once seemed affordable now strain household budgets.
Health insurance that eventually covers pre-existing conditions offers long-term protection by:
Over time, this protection becomes essential rather than optional.
Insurers typically determine pre-existing conditions based on your medical history. This includes any diagnosed illnesses, injuries, or treatments you may have received before applying for insurance coverage. They may ask you to undergo certain Medical examinations and access your records to examine your health status and identify any pre-existing conditions you may be diagnosed with.
Disclosure is the foundation of a valid insurance contract. Any gap between actual health status and declared information can lead to serious consequences.
Non-disclosure is one of the most common reasons for claim rejection. If an insurer discovers that a condition existed before policy purchase and was not disclosed, claims related to it may be denied.
In some cases, even unrelated claims can face scrutiny.
Accurate disclosure allows the insurer to issue the policy with correct terms.
Benefits include:
Transparency works in the policyholder’s favour.
The IRDAI has mandated insurers to provide insurance even to individuals diagnosed with pre-existing health conditions. But there may be instances when insurers may deny your application for medical insurance due to pre-existing ailments. The denial in coverage could apply to certain, specific ailments, like cancers, diabetes, or heart conditions you may have been diagnosed with in the past. In other cases, you may be deemed eligible for insurance despite your pre-existing conditions, but certain illnesses may be excluded from the scope of coverage.
To apply for insurance with pre-existing conditions, follow these simple steps:
Remember, being truthful from the start helps ensure you get the coverage you need.
Pre-existing conditions can increase insurance costs. Since pre-existing conditions indicate higher health risks, insurers may charge higher premiums for coverage. Being transparent about these conditions during application ensures fair pricing. While premiums may be higher, having insurance tailored to your needs is crucial for comprehensive coverage when dealing with pre-existing conditions.
Some pre-existing conditions place applicants in a higher risk category. This does not mean rejection. It simply means the insurer adjusts terms to reflect the increased likelihood of claims.
Risk classification affects:
Premium loading is an additional charge applied due to a higher health risk.
Factor
Impact
Chronic condition
Higher loading
Controlled illness
Moderate loading
Multiple conditions
Increased premium
While higher premiums may feel discouraging, they ensure continued coverage without claim disputes.
Different health insurance plans come with different types of waiting periods. In case of medical insurance for pre-existing conditions, the waiting period typically depends on the existing illnesses and your chosen health insurance plan. Thus, the waiting period can last anywhere from 24 to 48 months.
Most health insurance plans impose a waiting period for pre-existing diseases. This period usually ranges from two to four years.
During this time:
Once completed, coverage begins automatically without additional approval.
Certain strategies can help manage or shorten waiting periods:
Early planning always works better than reactive buying.
Whether or not pregnancy is deemed a pre-existing condition depends on when you purchase the policy.
Maternity benefits often have separate waiting periods, even if linked to pre-existing conditions like PCOS or thyroid disorders.
Key points to note:
Understanding these rules is crucial for family planning.
If you have any pre-existing health conditions and are looking for optimum coverage, you can check out the plans we offer at Manipal Cigna Health Insurance. Our health insurance plans are designed to cover a range of medical conditions – general, pre-existing, critical, and more. With Manipal Cigna, you can buy health insurance plans online with easy, effortless digital documentation and enjoy the benefits of extensive insurance coverage.
Choosing the right insurer matters as much as choosing the right plan. ManipalCigna is known for its customer-focused approach and comprehensive health solutions.
Their plans are designed to address both immediate healthcare needs and long-term conditions, including pre-existing diseases.
Highlighted features include:
These features provide reassurance and flexibility across life stages.
The buying process is straightforward and transparent.
Steps involved:
Proper disclosure at this stage ensures smooth claims later.
Pre-existing conditions and health insurance are closely interrelated. It is important to know what medical history means to insurers to make informed choices. Whether it is disclosures or waiting periods, each of them contributes to the development of your coverage.
An intelligent mindset today can do away with financial pressure tomorrow.
Honest disclosure builds trust and protects your interests. Even in the case of chronic health condition management, the right plan, selected early, provides long-term security and peace of mind.
Any disease, trauma or condition that is diagnosed or treated prior to the purchase of a health insurance policy is a pre-existing disease.
Yes. Non-disclosure of known medical conditions can lead to claim rejection or policy cancellation.
The waiting periods are typically two to four years, depending on the plan and the insurer.
Most comprehensive plans do, but terms vary. There can be permanent exclusions to certain conditions.
Waiting periods can be controlled by purchasing in advance, having continuous coverage and taking shorter PED plans.
