Articles 112 views August 29, 2020

Everything You Need to Know About Health Insurance & Pre-existing Illnesses

When you are buying a health insurance policy, you must read its terms and conditions carefully. Because if you haven’t done so, it might create a problem for you later. And in this post, we are discussing the same. Here you will know why you should tell about your Pre-existing Illnesses when you are buying a health insurance policy. The insurance company will assess all your medical conditions before accepting your insurance request. And if you try to hide any information from the company, you could be caught napping when denied an insurance claim for the treatment of such diseases. So, if you don’t want to face a situation like this, you should disclose your pre-existing illness honestly. The policy may not cover your pre-existing illness in the beginning, but telling the same to the insurer upfront will put you on the right track. Read this post further to know in detail why it’s important to tell your insurer about your pre-existing diseases.

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What is a Pre-Existing Illness?

A Pre-Existing Illness is a disease which the insured is suffering from before the issuance date of the policy. It also includes the following –

  1. Diagnosed illnesses name
  2. Medical history of illness such as heart attack, gestational diabetes, etc.
  3. Hospitalization history in case of angioplasty, kidney stones, etc.
  4. Signs like an increase in sugar level, obesity, etc.
  5. Symptoms of brain fog, feeling sweaty, etc.
  6. Medication for disease or illness if you are getting a treatment
  7. Major accidental injury

This is why health insurance companies require your pre-existing illness details; individuals with health problems have a higher chance of recurrent policy claims.

Terms & Conditions For a Pre-existing Illness

  1. Premium Loading: As per the Insurance Regulatory and Development Authority of India (IRDAI), insurance companies cannot increase the premium of the policy for any illness that occurs after policy issue or renewal without any break. In case the insured person has a pre-existing ailment, the premium would be higher compared to others.
  2. Waiting Period: The insurance company keeps a predefined waiting period of 2 to 4 years, although it may vary from one insurer to another. When the waiting period is over, your pre-existing illnesses get covered under the policy depending on the plan you choose.
  3. Waiting Period Plus Premium Loading: In some instances, you may have both the waiting period and the premium loading on your health insurance.
  4. Medical Check-up: A medical check-up is an examination for the insured person. Health insurance companies tell it before providing coverage to the policyholder. This test includes a detailed health check-up of the person, which makes the claim procedure easy and reduces your premium. However, the medical test is required only for applicants over 60 years, and not all insurers offer a pre-medical check-up.
    1. The pre-medical check-up is important because it sets a benchmark against which the insurance company measures your health. These medical tests bring light to any of your existing illnesses, which enable the insurance companies to provide you a suitable cover. Here are the benefits of pre-medical check-ups.
    2. Hassle-Free Policy Claim
    3. Lower Premium Rates
    4. Suitable Coverage
    5. Rewards & Discounts
    6. Low Stress
  5. Permanent Exclusion of Pre-Existing Illness: Some insurance companies won’t cover the pre-existing illness as they don’t have the waiting period clause. The decision of whether to exclude the pre-existing illness permanently varies from insurer to insurer. So, if you have a pre-existing illness, avoid choosing health insurance companies that don’t have a cover for the same.
  6. Policy denial: The insurance company can reject your insurance coverage based on pre-existing illness. In such cases, the insurance company will deny your insurance application to purchase a health insurance policy. So, while you are looking for a policy, do check their terms and conditions to know whether they accept your pre-existing condition or not.

What are the Consequences of Hiding Pre-existing Illnesses?

Suppose Ramya is a 35 year old woman who has bought a health insurance policy in which she declared that she doesn’t have any pre-existing illness. Actually, a year before, Ramya had undergone a kidney stone treatment, but she didn’t mention the same in her insurance application because that medical condition has already been taken care of and she thought there is no harm in it.

After two years, Ramya is hospitalized due to an injury. When she requests to claim her Sum Insured, it gets rejected. This is because Ramaya hid her pre-existing condition and the treatment she has undergone to remove the kidney stones.

So, you should disclose your pre-existing medical conditions before buying a health insurance policy.

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