Health insurance plans provide financial coverage in time of planned or accidental emergencies in India. However, the coverage comes into effect only when claims made by the insured get approved by the insurer. Oftentimes, health insurance claims get rejected and pre-existing diseases play a part in most of the claim rejections.
A few months back, one of my friends had bought a health insurance policy online for his mother. At the time of buying the health cover, his mother was not suffering from any disease so my friends didn’t mention any pre-existing ailments. After a year, his mother met an accident and made claims on her health insurance policy. But, her insurer rejected the claim and cited тАШnon-declaration of pre-existing illnesses the reason behind the claim rejection.
In the above-mentioned incident, neither the health insurance company cheated nor my friend lied. The claim denial was the outcome of miss-interpretation of pre-existing diseases. Not only my friend but also many policyholders don’t have a clear concept about pre-existing ailments and therefore they fail to make the most of the coverage offered by their health plans even after paying the premium on a regular basis.
What Exactly is Pre-Existing Condition?
Essentially, ailments or conditions that exist prior to the purchase of health insurance are considered as a pre-existing condition. However, the term encompasses following conditions as well:
- Medical history of high blood pressure, high blood sugar, diabetes and similar diseases
- History of hospitalisation for treatments like┬а bypass surgery and┬а angioplasty
- On medication for ailments like diabetes and hypertension
- Symptoms like sweatiness or brain fog
- Different types of skin diseases such as vitiligo and psoriasis
All these conditions are considered as pre-existing and concealment of any of these conditions can lead to rejection of the claim in the time of medical and financial exigencies.
How does Pre-Existing Illness Impact Your Coverage?
The insured in question or my friend’s mother was on medication to keep her high blood pressure in check. Since it was not mentioned at the time of availing health insurance, her claim was denied. It is therefore absolutely essential to disclose all types of pre-existing conditions in the policy form to avoid rejection of claims. However, after making the declaration, it is difficult for a person with pre-existing diseases to procure a good health insurance online policy in India. Even if the provider’s issue policies they impose certain terms and conditions in order to mitigate the risk of covering pre-existing ailments as these people are highly likely to make frequent claims in near future.
Some Terms and Conditions to Cover Pre-Existing Conditions
The following are the clauses that health insurance companies in India put up for people with pre-existing conditions.
If you suffer from hypertension or diabetes at the time of buying health insurance plan, you need to pay a higher premium than any hale and hearty person of same age. Your pre-existing disease makes your profile appear risky to your insurer and hence they charge an additional premium. However, the premium loading can happen only once, at the time of buying health insurance plan and not on subsequent renewals. Furthermore, if the disease is occurred after the issuance of the policy and the insured renew the cover without any break; premium loading is not applicable.
Most health insurance companies in India come with a waiting period clause for policyholders with pre-existing conditions. The duration of waiting period varies from one provider to another and in the range of 2-4 years. The simply implies that coverage of pre-existing diseases is available after the stipulated waiting period. If you have hypertension and your health plan impose a waiting period of 4 years for the same, you will get coverage for hypertension after completing 4 continuous years without a break.
Some health insurance plans come with both premium loading and waiting period clause to minimise the risk of the insurers. The insured not only have to wait for the waiting period to be over but also have to pay a higher premium to get coverage for the pre-existing disease.
Some health insurance companies arrange for medical check-up upon disclosure of pre-existing diseases. The issuance of the policy depends on the result of the medical test of the proposed. For an example, if you have been suffering from diabetes and have chosen any particular provider to avail health insurance plan online, your chosen insurer might arrange for a test to check the sugar level in blood and make the decision about issuing policy according to the result of the test.
Permanent Exclusion for the Pre-Existing Condition
A few health insurers in India neither increase the premium nor impose a waiting period to people with pre-existing conditions. These insurers simply take that particular disease away from the ambit of coverage. If you have been suffering from diabetes, your insurer would exclude treatments costs for diabetes and related illnesses permanently from the coverage.
Apart from these restrictions, pre-existing diseases may lead to rejection of the policy issuance as well. Usually, health insurance companies in India don’t cover people with a medical history of severe ailments such as cancer, heart attack etc.
Apart from pre-existing conditions, insurers may also deny issuance of health insurance plans or charge a higher premium if the proposer has harmful habits like smoking, heavy drinking, and the likes as these habits make the proposed susceptible to fatal diseases in the future.
DOs and DONTs Around Pre-Existing Diseases
To steer clear of these terms and conditions and to ensure that your application for a comprehensive health insurance online plan in India wouldn’t be refused, you can do the following:
Reveal Your Pre-Existing Disease
If you divulge facts regarding your pre-existing disease before buying a health policy you would know the terms and conditions that you have to accept to avail the health cover. Then, it is complete up to you whether you agree with the clauses and buy health insurance plan or decide against it.
Get a Health Check-Up Done
You should also get health check-up done voluntarily. A thorough check-up will not only determine if you have any pre-existing disease or not but will help you get a health insurance policy without much hassle in India.
List of Popular Health Insurance Plans with Waiting Periods in India┬а
There is no dearth of health insurance plans in India and all policies vary in terms of premium and waiting period. Here is a list of top individual health insurance online plans with premium and waiting period for a male person in the age-group of 31-35 years living in Kolkata, India. The premium is for a Sum Insured of Rs. 2 Lakhs.
|Bharti Axa||Smart Health Insurance Policy – Basic Plan||Rs.1641||4 years|
|Bharti Axa||Smart Health Insurance Policy – Premium Plan||Rs. 2121||4 years|
|Star Health||Medi Classic – Individual||Rs. 3312||4 years|
|TATA AIG||Medi Prime||Rs. 3467||4 years|
|Apollo Munich||Easy Health Individual Standard||Rs. 3695||2 years|
|National Insurance||Individual Mediclaim||Rs. 3779||4 years|
|Universal Sompo||Basic||Rs. 2618||3 years|
|Apollo Munich||Easy Health Individual Standard Two Year||Rs. 7285||3 years|
Pre-Existing Conditions are not a Bitter Pill Anymore
Jivan Sharma is my neighbour who is a 40 years old man. He had suffered from a heart ailment 7 years ago and had undergone a surgery. Now he is completely cured but due to his medical history, he is unable to avail a suitable health insurance plan.
Very recently, IRDA has come up with a standardised definition of pre-existing illness in the context of health insurance. According to IRDA, pre-existing diseases are termed as тАЬany condition, ailment or injury or related condition(s) for which the insured had signs or symptoms, and/or was diagnosed, received medical advice or treatment within 48 months prior to the first policy issued by the insurer.тАЭ
This definition simply means that any disease that occurred more than 4 years ago but didn’t relapse afterwards is not subject to a waiting period. According to this definition, Mr SharmaтАЩs earlier heart condition would not be termed as a pre-existing illness and he can avail any health insurance plan of his choice without having to pay a higher premium or being restricted by a strict waiting period. Still, it is better to declare earlier health complications in the proposal form to avoid claim rejection later.
┬аThe majority of the claims rejected by health insurers in India are due to the violation of pre-existing conditions clause. To ensure that you get a quality health insurance plan that gives you adequate cover, you should not hide any ailment. This will provide you with clear guidelines about coverage of pre-existing conditions so that you can make claims accordingly and successfully. There are scores of health insurance plans available in India with a varied range of waiting period. So you should compare health insurance online on neutral online insurance marketplaces like GIBL.IN and buy the best health insurance plan in India as per your requirement and budget.
Disclaimer by InsuranceBlog -This is a guest post by Priyanka Deb of GIBL.IN. http://insuranceblog.asia is not associated with Ms. Priyanka Deb. This post is purely for knowledge sharing┬аpurpose.┬аInsuranceblog.asia have not received any monetary benefits for publishing this post or for referrals.┬аPlease visit any link outside http://insuranceblog.asia at your own risk.