What are the Best Health Insurance Plans for Pre-Existing Diseases in India?

A few days ago, a client approached an advisor at Ditto. He was 28 years old and was looking for a health insurance policy. However, the issue was - he had hypertension. His concern was whether he would be able to get a policy at all.

Here’s what our advisor told him- “We can definitely offer you one of the best health insurance plans for pre-existing diseases. However, there will be some restrictions and limitations that you should be aware of.”

Now, while a call with one of our insurance advisors will offer you a solution, you might as well read through this article too. This piece will disclose all about the best health insurance policies for pre-existing diseases, things you need to remember while purchasing such plans and more.

Best Health Insurance Plans for Pre-Existing Diseases in 2024

*This is a general list, but coverage depends on a case-to-case basis.

**Assumption: 30-year Old Male | Zone 1 | 1 Benign PED

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What are Pre-Existing Diseases in Health Insurance?

Pre-existing diseases (PEDs) are medical illnesses you have before applying for a health insurance policy. These conditions can include chronic illnesses like diabetes, hypertension, asthma, and heart disease, as well as other specific conditions such as renal calculi (kidney stones), arthritis, or hypothyroidism.

Insurers are particularly cautious about PEDs because if you have these conditions, you are at a higher risk of hospitalisation, which, naturally, leads to higher claims. This is why health insurance companies scrutinise these risks more carefully before issuing the policy. Depending on the insurer's evaluation, they may impose waiting periods, increase premiums, or even permanently exclude coverage for certain conditions.

Let’s understand this better with an example:

Let’s say you have been diagnosed with diabetes and hypertension three years before applying for health insurance. According to current IRDAI Norms, these conditions are classified as pre-existing diseases.

Upon applying for a health insurance policy, the insurer will assess these conditions and might impose a waiting period. During this time, any medical expenses related to diabetes or hypertension, such as medication, doctor visits, or hospitalisation, will not be covered. The insurer may also add a loading charge to the premium due to the increased risk of claims associated with these conditions.

In some cases, if the diabetes is particularly severe, the insurer may permanently decide to exclude diabetes-related treatments from the policy coverage. This means you will have to bear all costs of this ailment out of pocket even after the waiting period.

However, accurately disclosing all existing conditions and consulting an honest health insurance advisor before purchasing a policy can avoid complications when making a claim.

What are the Best Health Insurance Plans for Pre-Existing Diseases in 2024?

Numerous policies offer coverage, and choosing the best health insurance policy can be laborious. Here, we have simplified the process for you by shortlisting some top picks for the top health insurance policies that cover pre-existing diseases in 2024:

• Care Supreme: Care Supreme is designed for extensive coverage, especially for those with pre-existing conditions. It covers a broad spectrum of PEDs, including cholesterol, BP, and asthma. Depending on the condition and add-on you pick, the waiting period varies from 30 days to 4 years.

Drawbacks: While Care Supreme is an affordable health insurance policy, Care, as an insurer, can have slightly better operational metrics.

• HDFC ERGO Energy: HDFC ERGO Energy specifically covers people with diabetes (both Type-1 and Type-2) and hypertension. This policy's significant advantage is the absence of a waiting period for these conditions, making it an attractive option for those needing immediate coverage. However, it comes with significantly higher premiums compared to other policies.

Drawbacks: While HDFC ERGO Energy covers Diabetes and Hypertension from day 1, it is quite an expensive health insurance policy. Apart from this, you cannot port to Energy, as the facility is unavailable. However, you can port to another policy from Energy.

• Niva Bupa ReAssure 2.0: Niva Bupa ReAssure 2.0 offers a balanced approach with comprehensive coverage for various PEDs, including cholesterol, BP, asthma, hypothyroidism, renal calculus, gall bladder stones, ligament tears, arthritis, hypertension, diabetes, hysterectomy, and BPH. The waiting period for these conditions ranges from 2 to 4 years, making it a competitive option in terms of coverage and affordability.

Drawbacks: While Niva Bupa ReAssure 2.0 is loaded with features and offers a high coverage amount, its operational metrics could be higher.

• Aditya Birla Activ Health Enhanced: Activ Health from Aditya Birla covers multiple pre-existing conditions after the waiting period, such as asthma, cholesterol, hypothyroidism, hypertension, etc. The waiting period is 3 years, and the policy is priced on par with its peers, offering good value and extensive coverage.

Drawbacks: While Aditya Birla has good operational metrics for a new entrant, we feel they can improve their metrics in the near future.

Things to Remember when Purchasing a Health Insurance Plan if you have Pre-Existing Diseases

Even the best policies have some restrictions, and when considering a health insurance policy, here are some essential points to consider:

1. Not all health insurance policies cover pre-existing diseases: Health insurance policies have varying approaches to pre-existing diseases (PEDs). Some policies include PEDs but impose a waiting period on them, which means claims related to these conditions are not covered until after the waiting period. And some other policies may have permanent exclusions, especially for severe conditions such as advanced heart disease or cancer. This means that while the policy will cover new illnesses, it will not cover treatment related to these excluded conditions. It’s important to read the policy documents carefully and understand the specific terms and conditions for PED coverage to avoid unpleasant surprises when making a claim.
2. Pre-existing diseases increase the cost of your premiums: Insurers consider pre-existing diseases a higher risk because they are more likely to result in claims. To offset this risk, insurers often increase the premiums for individuals with PEDs. This increase is usually in the form of a loading charge – an additional percentage added to the base premium. For example, if you have diabetes, the insurer might add a percentage of your base premium as a loading charge. Apart from this, insurers may also require a co-payment, where you must pay a certain percentage of the treatment cost out of pocket, with the insurer covering the rest. This co-payment can vary widely, from 10% to as much as 50%, depending on the severity of the condition and the insurer's policies.
3. Health Insurers may reject your policy based on the PED: The severity and nature of pre-existing diseases also significantly impact the insurer’s decision to accept or reject an application for the policy. If the insurer deems the risk too high, they may reject the application outright. This is more common if you have severe or multiple pre-existing conditions, such as advanced heart disease, chronic kidney disease, or certain cancers. You should always disclose your complete medical history during the application, as nondisclosure can lead to policy cancellation or denial of claims later. Seeking advice from insurance advisors knowledgeable about which companies offer the best coverage for specific conditions can also be beneficial.

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Conclusion

Choosing the right insurance policy is quite taxing, more so if you have pre-existing diseases. You need to consider various factors such as loading charges, waiting periods, and whether or not the policy even covers your ailment after the waiting period. This is why choosing one of the top policies in 2024 can ensure that you get the best possible coverage.

However, there’s no one-size-fits-all health insurance policy, so it’s always best to consult a trusted insurance advisor to find the best health insurance plan tailored to your needs.