Pre-existing Condition: How Does it Influence Your Health Cover?

You’re mistaken by referring pre-existing condition only for treating a person with an illness at the time of purchasing a health plan. It includes other conditions as well including:

  • Medical history of ailment
  • Hospitalization history: Hospitalization in case of angioplasty, kidney stone, etc.
  • Increase in sugar level, obesity, etc.
  • Symptoms of brain fog, feeling sweaty, etc.
  • Any medication is taken for diabetes, high BP etc.
  • Any skin disorder like Vitiligo, Psoriasis etc.
  • Major injuries like head injury, prosthetic limb, etc.
  • In case the applicant id diagnosed with ailments like Diabetes, hypertension, etc. at the time of taking a plan.

How Pre-existing Ailment Affects Your Cover?

You may face difficulties buying heal insurance with a pre-existing illness, as often the insurers are unwilling to cover a person with such conditions. Same goes with life insurance plans as well. Insurers believe that a person with a pre-existing illness is prone to claim his insurance on a frequent basis.

Here is why the insurance companies put certain terms and condition in case the policyholders declare any pre-existing condition. Here we go:

  • Premium loading: You may end up paying a higher premium for a pre-existing ailment. This is termed as premium loading. Because of this, you will be required to pay a higher premium than a person with the equal age but with no ailment. For instance, you have informed the insurer about your health condition which diagnosed you with diabetes. Because of that when your policy renewal date arrives, you may end up paying a higher premium than the other person with no illness.However, the insurance company load the premium only at the time of purchasing a plan. In case any disease that occurs after you purchase a plan cannot be considered and no premium loading is applied.
  • Waiting period: For every pre-existing illness, the insured has to serve a defined waiting period as per the terms of IRDA. Most of the time it is ranging from 2 to 4 years but may differ insurer to insurer. If you have hypertension and the policy that you bought from national insurance covers you for the same only after you serve 2 years of the waiting period. In this case, the expenses made for hypertension will be covered only after you make national insurance mediclaim renewal for the continuous third year.
  • Premium Loading + Waiting Period: Sometimes you may have a waiting period and premium loading. Let’s say, you have diabetes and already informed the insurer about this. The plan you opted for has 4 years waiting period to serve for pre-existing illness. On the other hand, because of this, you will have to bear a higher premium than the person with same age but no illness. That means you may have to serve both the conditions of premium loading and your health condition will be covered only after you renew the policy for the continuous 5th year.
  • Health Check-up: In case of pre-existing ailments, chances that you might undergo a health check-up, basis on which the insurer would decide whether you’re eligible to buy a plan or not. So, in your case, your sugar report will be checked by the insurer, as you’ve mentioned about having diabetes.
  • Permanent Exclusions: Mind It
    Insurance companies are authorised to permanently exclude a health condition or only after you agree on no cover for that particular disease. This may be risky or you may experience heavy medical expenses incurred during a treatment in the future.
  • Policy Rejection
    The insurer has the right to deny offering a policy to you, basis of a chronic pre-existing disease like severe diabetes or cancer or heart attack etc. If a chronic illness is detected, the insurance company may deny your application for issuing a health plan.

Moreover, if you lead a healthy life so far but addicted to smoking or drinking or other habits that can make you vulnerable to severe illnesses in the future. In such cases, the insurer may ask you for considerably a higher premium.

This way, your pre-existing condition may affect your health cover. It is advisable that you don’t hide anything from the insurer and maintain a transparency in everything.

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