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- Introduction
- What is a pre-existing disease?
- Ten Common FAQs related to Pre-existing Disease
Introduction
We can't predict a future illness, but there’s one thing we can be certain of - someone with a pre-existing disease has a higher chance of falling sick, and needing hospitalization sometime in the future. And if the person is covered under health insurance, there are higher possibilities for them to file a claim. Hence, insurance companies think twice before issuing a health insurance cover to someone with pre-existing disease.
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What is a pre-existing disease?
A ‘pre-existing disease’ is described as any condition, ailment, injury, or disease diagnosed or treated by a physician 36 months prior to the date of issue of your health insurance policy.
Note: Earlier, a pre-existing disease was any disease or condition that was diagnosed, treated, or sought medical advice in the last 48 months. This has been changed to 36 months, from 1 April 2024.
In this article, we’ve tried to provide answers to some commonly asked questions about pre-existing diseases.
So, let’s dive right in.
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Ten Common FAQs related to Pre-existing Disease
1 - Will I get a health insurance policy if I have a pre-existing disease?
This will depend upon the type and severity of the pre-existing disease you have. Generally, most insurers have a list of blacklisted diseases (eg. any type of cancer, hepatitis B/C, etc.) and if you have a pre-existing disease that is on this list, the insurer won’t issue you a policy at all.
Sometimes, the insurer might issue a policy to you even if you have a pre-existing disease - but there could be certain restrictions. They could either exclude it permanently from your health insurance cover or impose a waiting period on it.
Therefore, whether you’ll get a health insurance cover if you have a pre-existing disease or not, depends entirely upon the disease you declare, the insurer’s underwriting, and their risk-taking capacity.
2 - Can there be any issues with claims if I have a pre-existing condition?
As long as you have been diligent and made honest and accurate medical declarations at the time of buying the policy, you don’t need to worry about anything. Just make sure that if you get hospitalized, the family member who is providing your medical details is well aware of your medical history. Because if the history they provide doesn’t match with the details the insurance company has, it can impact your claim.
3 - Can an insurer hold me responsible for a disease I wasn’t aware of?
Sometimes, you could discover an existing disease many years after you’ve had it. You might not have got tests done, or even with tests, it is possible that some diseases are not clearly diagnosed by doctors. This shouldn’t be a problem for you to get a health insurance claim. As long as you’ve done your due diligence and provided every medical detail you know of, with utmost honesty, no insurer can hold you responsible for not disclosing diseases you yourself aren’t aware of in the first place.
4 - What should I do if I missed informing the insurer about a disease or health condition and realized it later?
In such a scenario, you should inform the insurer as soon as you realize this. The insurer will then re-evaluate your policy and decide to either continue, change terms (pricing, waiting periods, exclusions) or cancel the policy altogether. If you don’t inform the insurer and they find out about it later, they can reject your claim on grounds of misrepresentation despite you paying several premiums.
5 - Is it true that the insurer cannot decline a claim after 8 years of my policy?
The 8-year moratorium states that insurance companies cannot contest a claim (unless proven fraud) under a health insurance policy for ‘oversight’ in mentioning a pre-existing disease after the 8 years of continuous coverage. This moratorium stands valid only if you can prove that the misrepresentation was just an ‘oversight’ - and unintentional.
Note: From 1st April 2024, the moratorium period has been reduced to 60 months from 8 years.
6 - Is it important to inform the insurer if I get diagnosed with a disease after the policy is issued?
You don’t have any obligation to declare a new health condition or even a habit to an insurer ‘after’ your policy is issued. The only exception is if you’re planning to upgrade your cover - in which case, you’ll have to make fresh declarations including all-new ailments.
7 - If I get diagnosed with a new disease after I purchase a policy, will it be covered?
Yes, if you get diagnosed with any disease after the policy is issued, it will be covered under your health insurance policy. Just make sure you inform the insurer about the newly diagnosed disease when you upgrade your cover.
8 - How good are the special policies for pre-existing diseases?
While these special policies for covering specific pre-existing diseases are excellent options as you can get covered immediately, they come with limitations such as co-pays, room-rent capping, waiting periods, sub-limits on various surgeries and treatments, much higher premiums compared to normal health plans, etc. Make sure you’re aware of this before you make the purchase.
9 - I have a pre-existing disease and am covered under health insurance. But I’m not happy with my current insurer. Can I port my policy to another insurer?
In theory, yes, you can. But in reality, insurers usually avoid taking up portability proposals of customers who have a pre-existing condition. And if you’re above 50, the situation could be even worse and portability could get very difficult. However, you can still try and apply for portability before the expiry of your existing policy.
10 - What should I do if I have a pre-existing condition but am not getting a health insurance plan of my choice?
It can be very tough for people with a pre-existing disease to get health insurance coverage. In our opinion, if the top plans with the best features are not available, you must compromise with the plans with lesser features and benefits, instead of waiting forever.
You should also explore group health plans with your bank, or other institutions which are easier to get, have fewer requirements, and can also be affordable. (There would be certain limitations in such group policies - but a moderately good cover is always better than no cover at all!)
Besides this, you should also build a health care fund and contribute consistently to it, because there will always be certain expenses that your health insurance won’t cover. A health care fund will help cover those expenses without depleting your savings.
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