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Pre-existing Disease: How It’s Determined and Its 3 Effects on Policy

B
Bajaj Finserv Health
February 16th, 2022
6 mins read

Key Takeaways

  • Pre-existing disease can be covered under a policy depending on the insurer
  • Non-disclosure of PEDs may lead to termination of policy or claim rejection
  • A PED can affect the premium, insured amount and the waiting period

Having a comprehensive health insurance policy is a necessity today. This is why people with a pre-existing disease (PED) need to be extra mindful of their policy cover. Fortunately, most insurance companies do provide cover for pre-existing diseases. The key point to note is that there may be a change in the terms and conditions, premium amount, or the waiting period. How your policy is affected by the pre-existing disease is dependent on your insurance provider. 

Read on to know more about the meaning of pre-existing disease, its identification and how it affects your policy.

What does PED Mean?

A pre-existing disease is an injury, ailment, or any other condition that was diagnosed or treated 48 months before buying a policy or its renewal [1]. This pre-existing disease can become severe in the long term that may pose a financial risk for the insurer. However, not all PEDs may be excluded from a policy. 

Some commonly included PEDs are:

Pre-existing Disease

Excluded PEDs include common diseases such as:

  • Viral
  • Fever
  • Cold and cough
  • Flu

The reason behind these exclusions is that they do not pose a long-term threat. The above list may also include other diseases depending on the insurance provider. 

Additional read: Pre-existing Diseases Health Insurance: 7 Important Things to Know

How is a PED Identified?

Health Checkups

At the time of purchasing your policy, your insurance provider may ask you to go undergo some medical tests. This is also known as a pre-insurance health checkup. Based on the results of these tests, the insurer will know if you have a PED or not. The insurer will also know about your health condition. Depending on the diagnosis, your policy and premium may change accordingly. In case of unfavorable test results, the insurer can also reject your policy application.

Medical History

Apart from health checkups, the insurer will also enquire about your medical history. This would give them a better assessment of your health conditions. You also need to inform your insurance provider about any diagnosis or health investigations conducted previously. Though some insurers may only ask for a medical history of 2-5 years, this time frame may vary from one insurance provider to the other. 

Disclosure by the Insured

At the time of buying a policy, your insurance provider may explain to you the meaning of a PED. This is to help you assess your health conditions. It will also help you determine whether you have a pre-existing medical condition. Be sure to address your concerns on pre-existing diseases to the insurer. 

Make sure that you disclose your pre-existing conditions before purchasing a policy. Failure to disclose these conditions may result in claim rejection. It may also lead to policy termination. Non-disclosure of PED is one of the common reasons why insurers reject insurance claims.

Policies based on the cover

How Does PED Affect Your Policy?

Premium

Depending on your health conditions, your insurance provider may change the premium amount. A pre-existing disease may cause a hike in your premium amount. This is to balance out the potential financial risk incurred by the insurer. Additionally, you may also get an instant cover for a PED by paying an additional amount on your premium. This is also known as premium loading. The added amount will cover the financial risk of the insurer and the health risk of the insured. However, the insurance company cannot load the premium for at least a year after the policy has been issued [2].  

Waiting Period

When a pre-existing condition is included in the cover, there may be a waiting period applicable. During this waiting period, you may not be able to file any claims or get coverage. Depending on your insurance provider, the waiting period may be between 1-4 years. The waiting period is also dependent on your PED as well as its severity.

Sum Insured

The sum insured is a personal decision and the insurer cannot decide that amount. If you have a pre-existing disease, it is advised that your increase your sum insured. This is to ensure that you have enough cover for any medical emergencies and treatment of PED. Remember that different insurance providers have different policies. Make sure you understand your policy terms and conditions before you finalize a policy.

Additional read: How to Choose the Perfect Medical Coverage for Your Health Insurance Policy

Many insurance companies offer cover for PED from day one on a relaxed underwriting norm. But, be sure to do your research as these may lack features and benefits you will need. This would help you make an informed and adequate decision for your health needs. You should also check out the Complete Health Solution plan offered on Bajaj Finserv Health. The plan comes with four variants giving you the options to meet your health requirements. Apart from giving you a cover of up to Rs.10 lakh, it also offers doctor consultation reimbursement and lab tests benefits. This way, you can insure and track your health with the help of tests!

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