What are Pre-Existing Diseases in Health Insurance?

With rising medical expenses, health insurance plans offer protection against hospitalization bills, but not against pre-existing diseases. Individuals with pre-existing conditions find it difficult to avail timely coverage as such conditions are covered only after a waiting period of 2-4 years. Read on to know all about pre-existing diseases in health insurance.

What is a pre-existing disease?

A pre-existing disease is a medical condition that you are already suffering from at the time of policy purchase. As the name suggests, PED refers to conditions that exist even before you pay the policy premium. This may include medical conditions like thyroid, diabetes, asthma, cholesterol, skin disorder, etc.

How does a pre-existing disease impact your health insurance coverage?
Under a health insurance plan, an insurance company offers protection to the policyholder against hospitalization expenses. In the case of individuals with pre-existing disease, insurance companies are aware that probability of claims can increase as such individuals are at higher risk of requiring medical assistance. Therefore, insurance companies are hesitant to provide coverage to individuals having pre-existing medical conditions.

Impact of pre-existing diseases on health insurance

Having a pre-existing medical condition can impact your health insurance coverage in the following ways:

Increase in premium: Also known as premium loading, insurance companies charge higher premiums to individuals having pre-existing medical conditions. The high premium charge is applicable only at the time of policy purchase and not at the time of renewal.

Waiting period: This refers to the period for which the policyholder must wait to get coverage i.e., any claim filed during this period is rejected by the insurance company. The waiting period for a pre-existing medical condition is usually 2-4 years, varying from insurer to insurer.

Medical check-up: In case of a pre-existing condition, the insurance company can ask you to undergo a medical check-up, based on which the premium will be charged. Depending on the test results, insurance companies can also deny providing coverage to you.

Permanent exclusion: The insurance company can offer you coverage but can exclude your pre-existing condition permanently.

Are pre-existing medical conditions covered in group health insurance?

Pre-existing medical conditions under the group health insurance are covered basis the policy terms agreed between the insurer and the master policyholder. Such conditions may have waiting period up to 4 years or might also be covered from day 1. Therefore, it’s critical to review the policy’s terms and conditions to understand the extent of coverage offered.

With Onsurity’s healthcare membership plan, please ensure you go through the terms of the active membership plan for complete understanding of the benefits. For clarity on the benefits and claims assistance for our members, our “Good Doctors” team is here to help.