What are Pre-existing Diseases and Conditions?

Pre-existing disease (PED or PEDs) is an essential component of your health insurance policy. The catch here is to understand the implications of pre-existing illnesses and ailments on your healthcare plan and insurance premium. What do we mean by this? Let us decode this point by point. 

To begin with, PED includes all kinds of illnesses/conditions (except for critical illness) that you as a policy buyer might be suffering from during the time of purchasing a health cover or before. Why? Because you will never know the health condition of your body until you undergo a comprehensive full body check-up!

As per IRDAI (Insurance Regulatory and Development Authority of India), a pre-existing medical condition refers to any form of the disease, ailment, sickness, and injury that a policy buyer is suffering from before or during the time of policy inception. In addition, one can only seek treatment for the PEDs after the initial waiting period. 

For example, if you are suffering from hypertension and have been diagnosed by a medical practitioner for the same over the last few years. When you go looking for a new online health insurance coverage plan, your hypertension will be labeled as a PED by the respective health insurance companies.

What is the Waiting Period in your Health Insurance Policy?

As mentioned above, the waiting period for pre-existing health conditions is the number of days you have to go through before making a successful claim on any PEDs. This also varies from one policy to another. To help you understand better, here is a comparative table of the different types of applicable waiting periods.

Type of
Waiting PeriodScope of CoverInitial Waiting PeriodThis period begins 30-90 days after the date of policy inception.

No ailments/conditions/illnesses will be covered. An accidental emergency might be considered - This also depends on the policy structure and insurance provider.

This is only during the first time of policy purchase; it is not applicable during renewal.PEDs Waiting PeriodRefers to the conditions that you have from before.

This is a waiting period of 24 to 48 months.

Your policy will not cover PEDs during this term.

The waiting period also depends on your age and health condition.Specific Condition Waiting PeriodRefers to only specific illnesses, does not include PEDs.

Relatively a shorter waiting period of 1 to 2 years.What is Included in PEDs?As per IRDAI, here is a list of common PEDs in most mediclaim plans:

Asthma
Diabetes
High Blood Pressure/Hypertension
Cancer 
Thyroid
Primary Healthcare (COPC)
Atherosclerosis
Lupus
Sleep Apnea
Epilepsy
Depression
Anxiety

Note: The list of PEDs mentioned above is not exhaustive. Health plans, policy providers, and general insurance companies (limited) have different terms and conditions regarding the waiting periods for PEDs.

Do’s and Don’ts for Pre-Existing Disease Cover

• Every health condition or doctor visit is not included in PEDs. Only certain conditions that have had a long-term effect on your health are considered as a PED.
• Do not hide your PED from the insurance provider. You must disclose all information related to your health condition before buying the policy. 
• Failure to declare PEDs can have unfavorable consequences. First, the insurance company will not cover the PED when it is detected at a later stage. Second, your claim will most likely get rejected.
• Always do a full-body health check-up before buying a new plan. The medical report will give an idea of your overall health, which will help in screening PEDs.

What is Waiver of Pre-Existing Condition?

As the name suggests, this is a benefit cover for PEDs and comes at the cost of an additional premium. The purpose of this cover is to provide for the cost of medical treatment and hospitalization arising due to PEDs. In short, if you purchase a waiver of a pre-existing condition, PEDs will be covered by your policy (but only after the initial waiting period). 

The Plum Benefit

Now that you know all about PEDs and the waiting period, it is time to take the next step. Group health insurance is one of the best ways to provide comprehensive medical cover for your teams. There is no waiting period applicable, secure your employees and their dependents from day one. Because with Plum Insurance, cover and care starts immediately :D

FAQ

Q. How do different health insurance companies determine the length of the waiting period for specific PEDs?

A. Insurance companies assess the risk associated with PEDs based on medical research and historical claim data. Therefore, the waiting period reflects the perceived risk of recurrence or claim likelihood. Each company applies its criteria, making it essential to compare policies.

Q. Are there any options for reducing or eliminating the waiting period for PEDs without opting for a waiver?

A. Few insurers may offer options to reduce waiting periods through higher premiums or health improvement programs. However, these options vary and are not universally available. Engaging in a healthy lifestyle and demonstrating improved health metrics might influence insurers to reconsider the waiting periods.

Q. How does disclosing a PED at the time of purchasing health insurance affect the premium costs, and are there ways to mitigate this impact?

A. Disclosing a PED usually leads to higher premium costs as it increases the insurer's risk. To mitigate this impact, individuals can shop around for plans with competitive rates for similar coverage or consider plans specifically designed for people with pre-existing conditions. Additionally, maintaining a healthy lifestyle and adhering to medical advice can also help in reducing premiums over time.