What is Pre-existing Disease in Health Insurance?
As per Insurance Regulatory and Development Authority of India ( IRDAI), a Pre-existing Disease is any condition, injury, ailment, or disease, which is / are diagnosed by a doctor within 48 months (2 years) before the effective date of the insurance policy issued by the health insurance provider.
A pre-existing illness means any health issue that the proposer has been facing prior to purchasing a health insurance policy.
A pre-existing disease is an insurance term used to refer to a condition, injury or ailment, which already exists when a policyholder purchases a health insurance policy.
Often abbreviated as PEDs, the insurance provider generally excludes these conditions from the policy coverage until the policyholder rides out what is known as an ‘initial waiting period’.
Typically, the minimum and maximum waiting periods on such pre-existing diseases is anywhere between two and four years, respectively.
Premium Loading
There can be a scenario wherein you get instant coverage for your pre-existing disease but for a higher premium. This amount is added to the premium to cover the risks involved for insuring a person already affected by a medical condition.
Premium loading for ailments like diabetes and heart diseases is very common. Even with a higher premium, you are secure as the insurance will cover all expenses in case of lengthy hospitalisation or further aggravation of the condition.
It is also important to note that only at the time of buying the policy an insurance company can load your premium based on your pre-existing disease. As per IRDAI mandate, no insurance company can load its customer for any disease that occurs after issuing the policy and renewing it without any break.
List of Diseases regarded as Pre-Existing:
Health insurance providers typically enlist certain, specific diseases as pre-existing in the policy document. Here’s a list featuring some of the most common types of diseases or conditions that are generally regarded as pre-existing in all insurance policies.
- Asthma
- Diabetes
- High blood pressure
- Thyroid
Some diseases like HIV, etc. are permanently excluded from your policy.
Things to remember
- While purchasing a health insurance policy, you must truthfully disclose your medical history to your insurance provider.
- You must inform them if you are suffering from any pre-existing diseases.
- Failure to notify the insurer about pre-existing conditions can result in your claim being rejected.
- The insurer may also refuse to renew your policy.
- The insurer may levy a higher insurance premium if you’re suffering from pre-existing conditions.
