All About Pre existing disease in Health Insurance

Having health insurance for you and your family is a necessity these days. However, if you or any of your family members have a pre existing disease, it may not be easy to get a health insurance policy. It is important to know about the effect of pre existing diseases on health insurance.

Let us first understand what pre existing diseases mean.

What is a Pre existing disease in Health Insurance?

It refers to the diseases or ailments you are suffering from at the time of buying health insurance.

As per IRDAI (Insurance Regulatory and Development Authority of India) definition, pre existing disease means any condition, ailment, injury, or disease:

a)       That is/are diagnosed by a physician within 48 months before the effective date of the policy issued by the insurer.


b)      For which medical advice or treatment was recommended by, or received from, a physician within 48 months before the effective date of the policy or its reinstatement.

List of pre existing illnesses

It depends on the individual health insurance provider to list the diseases which they would consider as pre existing. Most of the insurers consider the below diseases as pre existing:

1.       Cancer

2.       Diabetes

3.       Thyroid

4.       Epilepsy

5.       Asthma

6.       High Blood Pressure, etc.

Health insurers consider only those ailments that will impact you in the long run as pre existing diseases. If you are prone to seasonal illnesses like cough, cold, and flu, it will not be considered as a pre existing disease.

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Why are health insurers concerned about pre existing diseases?

Though it is difficult to predict sickness in advance, people who already have health conditions are more likely to file a claim than those who do not have any. So, people with pre existing diseases pose a higher financial risk to the insurer.

How to buy health insurance when you have a pre existing disease?

Contrary to popular belief, you can buy health insurance even if you have pre existing diseases. Most insurers offer coverage for pre existing diseases also but with a specified waiting period. It means that if you get hospitalized because of your pre existing disease during the waiting period, the insurer will not provide the cover. However, if you are hospitalized for any other disease or illness during the same time, the insurer will settle the claims.

Example: Assume that you are a diabetic and bought health insurance today with a waiting period of 2 years. If you get hospitalized for any health issues related to diabetes within 2 years from today, the insurer won’t reimburse the claim.

Assume you get hospitalized for other reasons, let’s say dengue. In that case, irrespective of the waiting period, the insurer will settle the claim.

If you get hospitalized for diabetes-related issues two years after purchasing the policy, then your policy will provide cover for the same.

Effect of pre existing diseases on your policy

Waiting period for Pre existing diseases

Waiting period is a specific period during which you are restricted from filing a claim for hospitalization because of a pre existing disease specified at the time of buying the health insurance.

The time duration of the waiting period may differ based on your medical condition and the insurance provider as well.

Premium Loading

Many insurers charge higher premiums to provide health cover if you have any pre-existing disease. The additional premium is to cover the financial risk of providing health cover to a person with a known medical condition.

According to IRDA rules, Premium loading is allowed only during issuing the policy, and not allowed if any disease is diagnosed when the policy is in force.

Key Points to Know

1.       It is possible to get a health cover even if you have a pre existing disease. However, never fail to declare your medical condition.

2.       Health insurance terms and conditions for pre existing diseases differ from one another depending on the insurer. Before purchasing a health cover, look at the waiting period and the list of pre existing diseases that are covered after the waiting period.

3.       Your insurer might impose a waiting period for pre existing diseases. But the insurer cannot deny you any claims made during the waiting period for other health issues.

4.       Some diseases such as cancer, AIDS are permanently excluded from your policy. However, it depends on the insurer and the policy type.

5.       Some health insurers offer additional benefits cover called a Pre existing condition waiver. The pre existing disease clause will be waived off if you buy this cover along with your health insurance.

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