One of my relatives bought a health insurance policy for his father. At the time of filing the proposal form, he marked the absence of any ‘Pre-Existing’ condition, as his father did not have any illness or condition at the time when he bought the policy. After a period of 2 years of buying the policy, when his father went into the hospital due to an illness, the claim was rejected and the reason stated was ‘non-declaration of pre-existing illness’.
Although, my friend did not lie to the company, as his father did not have any illness at the time of purchasing the policy. He was not sure, about what could be the reason for rejection. Whether the insurance company cheated him? Actually, it was neither my friend who was lying nor the insurance company. The reason behind the rejection is the ‘pre-existing illness’, which he had not understood correctly.
In the last few years, the majority of the claims are not accepted on the ground of pre-existing illness. This impression may make you lose faith in health insurance. It’s not that health insurance does not cover the pre-existing illness. The only thing is that you need to understand the ins & outs of a pre-existing condition, before buying a health insurance policy.
Table Content
What is a Pre-Existing Condition?
It refers to a medical condition/disease/illness that existed, prior to buying a health insurance policy. It means the insurance company would not pay any claims for an illness, ailment, injury, or similar condition, for which you had symptoms, in your diagnosis reports, and/or received medical advice/treatment, before the commencement of the policy.
Although its definition seems quite simple, people often misinterpret it which leads to the rejection of claims.
If you have diabetes or hypertension, then it’s not that your claim will get rejected only for diabetes. There are various other illnesses that may cause due to diabetes and one of them is kidney failure, paralysis, stroke, and heart disease. So, these diseases will not include as stated under the policy.
Waiting Period of Pre-Existing Condition
Insurance companies do not cover pre-existing conditions during the 48 months of health coverage under the first policy. Pre-existing conditions are covered only after the completion of 48 months of continuous health coverage. However, this waiting period varies from 12 to 48 months, as specified under the policy schedule.
The treatment for such ailments you are eligible for only after completion of the waiting period as applicable. Health insurance requires you to pay premiums on time and you will get medical cover, even for pre-existing conditions. The only aspect to consider here is, you have to wait for the completion of the waiting period.
What exactly is a ‘Pre-Existing’ condition?
Well, very few people know about the ‘pre-existing’ condition and even fewer people know about this ‘pre-existing’ condition. ‘Pre-existing’ condition is not just a term in insurance but it itself refers to many different conditions of health.
- Medical History of Illness – One, who wants to buy a health policy, needs to clear his medical history. Medical history means, he/she has any kind of disease or had any disease before.
- Hospitalization History – In recent times, you went to hospitals for any kind of treatment or at any time in your life before buying the insurance policy.
- Doctor Consultancy – If you are facing any health problem, and currently you are taking medicine on doctor’s advice and also visit the doctor from time to time.
How does ‘Pre-Existing’ illness impact your coverage?
The decision to buy health insurance is much better and in today’s time health insurance has become a basic necessity for people but one truth that we all should know is that, if you have any ‘pre-existing’ disease and you are willing to buy health insurance then this may cost you a bit expensive.
Because as per insurance companies’ rules, the insurance company hesitates to insure a person who is already suffering from any disease. The reason for doing this is your pre-existing disease; the insurance company believed it to be because a person who is already sick has a higher chance of claiming it.
An insurance company insures a person who has a pre-existing disease, so the terms and conditions are different for them.
- Premium Loading – We all know that insurance premiums calculate with the help of your age and your sum insured, but if you have a pre-existing disease then it would be problematic for you. In this situation, the insurance company takes a higher premium than usual and this as you might know is a ‘premium loading’.
- Waiting Period – If the insurance company insured you then, they’ll impose conditions upon covering your pre-existing disease. To get Health policy coverage you have to wait for 2-4 years which is a waiting period
- Medical Check-up – There are some basic rule of buying a health policy is, you have to submit your current medical check-up because with the help of a health report insurance decides whether you are eligible or not for a health policy.
Disclose your ‘Pre-Existing’ Condition
While filling out the proposal form for buying health insurance, it is recommended to disclose your pre-existing condition. In case, you hide this medical condition, the insurance company makes several checks before settling the claim and one of which is a pre-existing ailment, they will not accept your claim if Pre-existing illness is not in your form and you are lying ,
When disclosing the pre-existing illness/ailment, you may pay with a higher premium, but the company will give you the cover and they don’t have any reason to deny the settlement of your claims.
Don’t forget to read these Articles: Health Insurance Policies cover Pre-Existing Diseases
Conclusion
A health insurance policy provides cover for unforeseen medical emergencies, even if you are having pre-existing ailments. Prior to buying a policy, it is advisable to read the terms related to pre-existing illness such as which illness or illnesses will be, its waiting period, and exclusions apply. It will help you choose a health insurance policy that covers your pre-existing condition and caters to your healthcare needs.