Are pre-existing diseases covered in your health insurance policy

Last Updated: Oct 31, 2014 | 1,919 Views

A pre-existing disease (PED) is that ailment or condition that exists in a policy holder before the inception of his health insurance policy. This term often raises several questions in a policy holder’s minds. When is it covered? Are they included in the policy at inception itself? Here are the answers.

The Concept of Waiting Period

Almost all health insurance policies have a waiting period. A waiting period or cooling period, is that period during which time, all or specified ailments may not covered by the policy. The prime purpose of waiting periods is to reduce any incidence of false claims by the policy holder. A standard health insurance policy comes with three broad categories of waiting period.


Initial waiting period:

Every policy has an intial waiting period of around 30 days (which may even go upto 90 days) from policy commencement, during which period, no ailments whether they are pre-existing or not, would be covered. Some insurance companies may however offer cover for treatment of any injuries that may arise from an accident, with a minimum of 24 hour hospitalization. This waiting period is not applicable when the policy is subsequently renewed.


The waiting period of PED

Insurance companies do offer a cover against pre-existing disease, but only after completion of a stipulated waiting period. Pre existing ailments are not covered from the beginning of the policy, but after a period of 2 to 4 years, depending on your age and type of ailment. During the course of this period, your policy may however be effective for other ailments. It is only your PEDs that would be excluded here. To avoid loss of PED coverage post this waiting period, most insurers insists on continuous claim free policy years, during the waiting period.


Specific ailment related waiting period

This waiting period may often be confused with the waiting period of pre-existing diseases. This waiting period relates to certain specific ailments such as hernia, polycystic ovarian disorders, hypertension or diabetes which are not covered immediately at inception but after completion of 1 to 2 years of policy. These ailments may have been contracted post inception of policy. The ailments vary from insurer to insurer and in many cases could be waived off too.

A Note on Waiting period and Health Insurance Portability

With IRDA approving health insurance portability, you could now carry forward your PED waiting period from one insurer to another. Prior to portability, shifting insurance companies meant the new insurer considered you a fresh customer and imposed his own waiting period on the fresh policy taken. Now with portability, you need not fear losing out on your PED waiting period, when you change your insurer.


Reading the Fine Print

When purchasing a health insurance policy, it is important to read the policy document properly. You need to be fully aware of the stipulated waiting period for an ailment, mentioned in your policy. A policy document would give you all the details required, when your ailments would be covered and when they would be excluded. A clear understanding is necessary to avoid any rejection of claims.  Health insurance policies specify a free look period of 15 days in the initial policy days. If you find any discrepancy in the policy, you could discontinue it during this period, failing which you would not be able to discontinue the policy.

Ramya Ramachandran
Ramya Ramachandran aggregates news on anything related to insurance in India. Keeps you updated.