Did you know that India has among the highest rates of medical inflation in Asia? Yes, with 14% inflation in medical expenses, Indian households find it increasingly difficult to afford quality healthcare. That’s why the demand for health insurance is rising (was up 25% in 2022). While health insurance plans in India cover a wide range of common medical conditions and critical illnesses, around 15% people below 45 years of age are unable to get health insurance due to pre-existing conditions. Here’s a look at what pre-existing diseases are and the options you have to get health insurance coverage for them.
What are Pre-Existing Diseases in Health Insurance?
Pre-existing diseases are ailments that you have prior to applying for a health insurance policy. As per IRDAI, these are diseases that you have been diagnosed with within 48 months before applying for health insurance.
Another criterion for a disease to be considered as a pre-existing condition for health insurance is that it is a long-term health issue. If you have been hospitalised for short-term health issues like pneumonia or dengue in 48 months before applying for health insurance, it does not impact either the cover or the premium.
The most common pre-existing condition that results in the failure of health insurance is diabetes. In fact, almost one fifth of people who apply for a medical insurance policy have uncontrollable diabetes as a pre-existing disease.
The other common pre-existing conditions are:
Heart disease
High blood pressure
Cataract
Asthma
COPD (chronic obstructive pulmonary disease)
Thyroid
HIV (human immunodeficiency virus)
Chronic liver, lung or kidney disease
Brain complications
Cancer
Pre-existing conditions could be a lifestyle disease or a result of family history. You may also develop it for no apparent cause.
Health Insurance Options for People with Pre-Existing Diseases
Most medical insurance policies do not cover pre-existing diseases. The good news is that you have options. The 3 main options are:
Health insurance with pre-existing diseases: Identify medical insurance policies that cover pre-existing conditions.
Health insurance policy with riders: Some health insurance policies offer basic coverage and allow you to add pre-existing conditions as a rider or add-on.
Separate policy for pre-existing diseases: If your current health insurance policy does not cover pre-existing conditions, consider taking a policy that covers only these ailments.
Here are a few things to know if you wish to get health insurance for pre-existing conditions:
Ensure the policy covers the disease that you have been diagnosed with. A medical insurance policy that includes pre-existing conditions may not cover them all. Check the list of diseases included in the policy before buying.
Whichever option you choose, there is likely to be a waiting period. This could be 2 or more years. This means you can file a claim for expenses incurred on the treatment of your pre-existing disease only after the waiting period is over. During this time, your health insurance policy is active for all other medical conditions.
The premium is likely to be higher than you would pay for a basic health insurance policy. You can compare premiums between policies as well as among the three options discussed above.
Health insurance is your safety net against rising medical costs. Ensure you’re completely truthful about your pre-existing condition when taking a health insurance policy. Failure to truthfully disclose the status of your health may result in your claim being rejected even after paying premiums.
