Does Health Insurance Policies cover Pre-Existing Diseases

Buying Health Insurance should be the first thing that you must do to protect yourself. Health problems can happen to anyone, and the implications of not having insurance can often be disastrous. It can lead to major out-of-pocket expenses that can deplete your life saving, and the tension about arranging for the money to pay the medical bills can cause major emotional distress as well. Pre-Existing Diseases are a matter to discuss before buying a health policy. 

Getting yourself covered by Health Insurance is very easy. You just have to buy a policy from an insurance company either directly or through an agent. There are various types of health policies available in India today, and you can choose the one that provides you the maximum coverage and benefits at an affordable cost.

Unfortunately, things are not so simple for people who have pre-existing diseases, i.e. ailments that the individual might already be suffering from on the date of buying the insurance policy. They might find it very difficult to get a comprehensive health insurance cover for themselves since most insurance companies like to stay away from insuring people with pre-existing diseases. The reason for this is not very difficult to understand. They feel that these individuals follow the high-risk category since they are more likely to fall sick frequently and as a result may require medical attention many times. In that case, the claims from these insurance policies will be more, resulting in a loss of profitability for the insurance companies.

To get over this problem, have introduced the concept of “Waiting Period”, which mandates that no claims can be made for certain diseases for a specified period of time after buying the policy. Even if the policyholder contracts any of these diseases during the waiting period, he cannot make any claims from the insurance company. This protects the insurance company from the possibility of fraudulent claims being made by some unscrupulous policyholders.

Types of Waiting Periods

The insurance companies in India follow three types of waiting periods. These are the Initial Waiting Period, Pre-Existing Diseases Waiting Period, and Specific Diseases Waiting Period.

• Initial Waiting Period: Insurance companies specify that no claims can be made for the first 30 days after the commencement of the insurance policy. Some insurance companies stretch this to 90 days and even 180 days. If you fall sick during this initial waiting period, then you will know I have no other option but to bear the expenses of treatment from your own pocket.

• Pre-Existing Diseases Waiting Period: This is applicable in the situation where there was a pre-existing disease before the commencement of the health insurance policy. Depending on the insurance company and their type of ailment, the pre-existing disease waiting period can be anywhere between a few months to a few years.

• Specific Diseases Waiting Period: Many insurance companies provide a list of diseases with each health policy that has a special waiting period attached to them. The specific disease waiting period tends to be the longest among all the waiting periods and easily stretches to 2 years from the date of commencement policy. The diseases that generally get covered under this waiting period are diabetes, hypertension, cardiac diseases, hernia, etc.

Know the waiting period before buying the insurance policy

As you can see, waiting periods are beneficial for the insurance companies, but not for the policyholder. Long waiting periods pose a problem since no insurance claims can be made by the policyholders if they fall sick within the waiting period.

Thus before buying health insurance, everyone should pay special attention to the waiting period attached to it. Normally, the policy document specifies the pre-existing disease coverage and also mentions the length of the waiting period attached to each of these diseases. Therefore, it is extremely important to understand the pre-existing disease coverage by reading the policy wordings carefully before paying the initial premium.

Avoid any policy with specifies unusually long waiting periods, even if it otherwise looks attractive to you. Remember that the longer the waiting period, the higher the risk to the policyholder. No one knows when one will fall sick, so there is no point in extra risk by buying a policy with long waiting periods.

It is also was remembering that hiding pre-existing diseases from the insurance company while buying the insurance is not a good idea. If the insurance company finds out about the pre-existing disease later, they most certainly will reject the claims made on such diseases, and in some cases may invalidate the policy altogether.

Some insurance companies allow their policyholders to reduce the waiting period by a few months or even years by paying some extra premium. If the policy looks attractive to you, it is definitely worthwhile to go for this option.

Points Should Consider in case of Pre-Existing Diseases

Premium Loading – One thing, which is clear and we all know that generally age and sum assured are required to calculate premium but no insurance company insures anyone till they submit their health report. Most importantly, if your health report reveals that you are suffering from any disease, then the premium will automatically be higher and your disease will be covered after a waiting period. But if you still want that the pre-existing disease can be covered immediately without a waiting period, then the insurance company will charge you a higher premium, and this premium amount is known as premium loading.

Premium loading and Waiting Period – Your policy premium and the waiting period can also be affected due to your pre-existing disease, the insurance company does a lot of investigation before insuring any sick person. Many times because of your pre-existing disease, the insurance company charges you a higher premium and they have to wait till the waiting period is over despite paying a higher premium. Usually, such a policy proves beneficial for the insurance company, and in such a situation buying insurance becomes costly.

Conclusion

Yes, there is no doubt that a health policy covers a pre-existing disease but it also comes with certain terms and conditions. Under the health policy, you have to wait till the completion of the waiting period before covering any pre-existing disease and if you claim before the completion of the waiting period, then the insurance company denies it outright. In the case of pre-existing diseases, you have to think a lot before buying a health policy and during this time buying a health policy is also not easy, just because of the higher premium and waiting period.