Do You Have Pre-Existing Diseases? Check How It Will Impact Your Health Insurance Premium!

Do You Have Pre-Existing Diseases? Check How It Will Impact Your Health Insurance Premium!
Do You Have Pre-Existing Diseases? Check How It Will Impact Your Health Insuranc
19 February 2024

People often underestimate the importance of having a health insurance policy. They rely on savings and employer-offered insurance. Without any doubt, health insurance is crucial, and this is especially true in India, where healthcare expenses have risen rapidly in recent years. Furthermore, our sedentary lifestyles have increased health risks, resulting in higher healthcare costs. In such instances, health insurance provides an extra layer of financial safety by assuring you can pay for the medical care at the time of need and that you have a certain level of financial stability to recover from such catastrophes.

While buying a health insurance policy, there are many important things to know beforehand. Pre-existing conditions are a term that many people are unfamiliar with in the context of health insurance. As a result, in this article, we will explain everything you need to know about it and how it influences your insurance premium.

What constitutes a pre-existing illness or disease?

Pre-existing illness in a health insurance policy refers to the health concerns or issues that the individual(s) had prior to purchasing the health insurance. This encompasses all health conditions, from high blood pressure to diabetes. When you buy health insurance, you must disclose any pre-existing diseases.

Why is it required to disclose pre-existing illnesses to the insurance company?

An insurance policy is a legal agreement. The health insurance provider examines the risks, accepts the plan, and sets the premium accordingly. This is the reason why the premium of each individual varies. The information you provide to the firm is used to assess your health status, which further sets the premium. These agreements are predicated on 'utmost good faith'; therefore, concealing the pre-existing disease violates the agreement. Furthermore, the coverage does not cover any medical issues that may emerge as a result of these complications. Any healthcare costs associated with pre-existing conditions will not be paid during the waiting period in health insurance. The waiting period varies depending on the policy. However, it is normally between two and four years.

On the other hand, if you notify the insurance provider at the time of purchasing the health insurance policy, illnesses will be covered under certain terms and circumstances and after a waiting period in health insurance.

What are the implications of pre-existing illnesses for health insurance?

Pre-existing conditions can have the following effects on your health insurance coverage:

Waiting length and Premium Loading: In some circumstances, health insurance requires you to pay higher premiums and wait for a set length of time before the policy covers the disease. If you want instant coverage for pre-existing illnesses, the insurance company can provide it, but the same comes at a higher cost. This is because pre-existing conditions pose high risks to the insurance company. This is a reason why insurance providers put up a waiting period in the health insurance clause in the policy.

Medical Examination: Should you have a pre-existing condition, the insurance provider may request that you have a medical examination. The test findings will determine the insurance premium. In the event that the outcomes are not good, there is a possibility that the insurance provider will decline to provide a policy.

Permanent Exclusion: It's possible that the insurance provider will grant you coverage but will not cover the pre-existing condition. Here, you will have to consent to the policy's permanent exclusion of the mentioned pre-existing condition. In this way, depending on the terms and circumstances of the policy, you may not be financially covered against an illness or disease but will be covered against other health-related events.

Denial of Policy: Due to a pre-existing ailment, the health insurance provider may decline to provide you with coverage. They will reject your application to get a health insurance policy in such circumstances.

When purchasing a health insurance policy for pre-existing conditions, keep the following in mind:

1. There may be differences in the terms and circumstances of health insurance for pre-existing conditions: Depending on the health insurance plan, kind of coverage one is offering, riders, insurance firm, etc., there may be differences in the screening procedure, waiting period in health insurance, list of pre-existing conditions they cover, etc. A medical examination is typically required by insurance companies before they would issue you coverage. A few insurers might also take your age and medical history into account. As a result, before choosing a medical insurance plan, you should review the terms and conditions of the said policy and the insurance company.

2. You must always make your prior medical conditions known to the insurance company: You would only make it more difficult for yourself if you withheld information from the insurance company or gave them false information. If a pre-existing ailment is not disclosed, the insurance company has the power to deny your claim and terminate your contract. In an emergency, this might be rather frightening. It is, therefore, in your best interest to always be truthful and provide the insurer with all relevant health information at the time of purchase.

3. Pre-existing diseases or illnesses are not always covered by insurance plans: Pre-existing conditions are not always covered by health insurance coverage. Certain plans might not provide any protection against these types of illnesses. As a result, you need to make sure with the insurance provider when you buy and choose a plan appropriately.

4. In certain circumstances, the waiting period may be waived: When an additional payment is paid, some insurance companies allow the waiting time restriction to be waived. With this option, the waiting period is either eliminated completely or has its duration shortened.

The insurance provider will, however, waive the premium in accordance with the seriousness of your condition. If your health is serious or you are relatively old, the insurance company might not even give you this option. Therefore, it's advisable to make sure of this before deciding to buy health insurance.

So, we are saying,

To summarise, pre-existing illnesses are those that the policyholder suffered from prior to purchasing the health insurance coverage. With such ailments, you will be compelled to either wait for a set period of time, pay higher premium rates, or both. However, do not commit the mistake of hiding them from your insurance provider. Not only is it a terrible idea, but the insurance provider has the right to refuse to cover the expenses associated with those diseases.


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