Taking care of one’s health goes way beyond eating green and living green. It also includes availing of health insurance plans that would be your financial shield during times of medical emergencies. And thankfully, there has been a growing awareness regarding the significance and role of health insurance that has led to a higher insurance penetration across the nation.

However, this awareness walked in late for some sections of the population who are already affected by some chronic/genetic diseases. Such diseases make them non-suitable applicants for some health insurance plans. On the other hand, some of the best health insurance providers across the nation are crafting plans that would specifically cater to these pre-existing disease-affected individuals.

So, which ailments fall under the pre-existing disease category in health insurance? Can you actually blindly trust all the health insurance plans for pre-existing diseases in India? What are the cautionary pointers that you have to notice when choosing such a health insurance policy? What are some of the best health insurance plans for pre-existing diseases in India that you can avail?

Take a look -

What are pre-existing diseases or PEDs in health insurance?

Pre-existing diseases, as the name suggests, are ailments that have been diagnosed in the individual prior to the purchase of the health insurance plan. Considering our recent hectic lifestyle and habits, we often fall prey to multiple ailments that can cause health complications. And in this case, age is no barrier. Such diseases can affect an individual of any age range. They can keep causing health hurdles in the future too and availing of a health insurance plan at the earliest is the exact financial-security measure that you need to take.

In the case of health insurance plans, any and all health conditions that have been detected in the individual prior to the availing of the health insurance plan are considered pre-existing ailments. Some such pre-existing diseases that are considered by health insurance providers are -

  • Blood pressure
  • Diabetes
  • Thyroid
  • Surgeries (across the last 4 years)
  • Cardiac issues, etc.

Based on this, sometimes health insurance providers can

  • Outright reject the application of an individual, or
  • Can even charge a much higher premium (that would include a high loading charge), or
  • Can put on an extensive waiting period clause in the health insurance plan prior to the completion of which, no coverage will be provided for the treatment of these conditions.
  • Can charge a mandatory copayment for the treatment of such diseases.

The insurers justify their decisions by explaining that these individuals with pre-existing medical conditions pose a much higher risk of payout over frequent hospitalisation and expensive treatment procedures.

As high-end as this sounds, not having a health insurance policy at all is much riskier and might end up becoming a pricier situation. Thus, one must be extremely careful when opting for a health insurance plan for pre-existing diseases. It is crucial that one weighs out its pros and cons and recognises the pointers that need to be avoided and considered when availing of such plans -


Things to remember when availing of a health insurance plan with Pre-Existing Diseases

  1. Not all health insurance plans offer coverage for pre-existing ailments

Catering to the rising demand for health insurance coverage, more and more plans have emerged to ensure the financial safety of insured individuals. However, not all plans offer coverage for pre-existing ailments. Only a few of the best health insurance policies cover such ailments. However, it is still advisable to enquire about the coverage prior to availing of any health insurance plan.

2.  Pre-existing diseases tend to spike the premium of health insurance policies

When it comes to individuals with prior medical conditions, they pose a high risk for insurance providers (as has been stated before). To safeguard their financial interest and well-being, health insurers often impose a hefty loading charge on the premium to be paid towards the plan. In this case, the premium gets significantly spiked. On the other hand, this spike in the premium can be handled when compared to having no coverage at all and the consequent charges to be paid for the treatment.

3.  Expect a waiting period for the treatment of those PEDs under your policy

The treatment of pre-existing ailments almost always has an extensive waiting period involved. This waiting period varies based on the following factors -

  • Health insurer
  • Pre-existing disease

During this span, health insurance providers refuse to provide coverage for specific pre-existing ailments. Any cost incurred for the treatments for those specific medical conditions during this span will have to be borne by the insured individual themselves. So, try and choose a plan that comes with the shortest waiting period.

(P.S. With some health insurance providers, you can waive the entire waiting period on your pre-existing ailments by paying a certain sum. However, not all health insurance providers offer this provision.)

4.  Health insurers can deny one’s policy application over a PED

If you are applying for a health insurance plan with some long-term severe pre-existing ailments, you should expect that there will be chances of your application being rejected completely. Under such circumstances, you would need to look out for the industry-best insurers who would offer coverage for the ailment. You can also contact neutral insurance experts who would give their unbiased opinion about the best plans for your medical conditions.

5.  Disclosure of any and all Pre-Existing Diseases is a must

Disclosing any health conditions is a must when availing of health insurance plans. While some health insurance providers request a complete medical and health checkup before purchasing a health insurance plan, others don’t. However, in the case of the latter, it doesn’t mean that you can hide your pre-existing ailment. Your medical history would be taken into consideration by the doctors in case of any hospitalisation and that would eventually get back to your TPA (Third Party Administrator) and/or your insurance provider who may reject your claim or altogether discontinue your insurance plan.

Thus, when your health insurance expert asks you “Are you on any medications?” or “Do you have any pre-existing health conditions?” be honest. The expert will be able to give you a customised plan that would specifically cater to your conditions sans you having to face the banter of too many terms and conditions.

Considering that now you know about the important pointers that you should keep in mind while you choose a health insurance plan that covers pre-existing diseases, it’s time you take a look at some such health insurance policies -

Best health insurance plans for people with Pre-Existing Diseases

The best health insurance plans Pre-Existing Diseases Covered Waiting Period
HDFC Ergo Optima Restore Cholesterol, BP, Asthma, Hypothyroid, Renal Calculus,
Gall bladde Stones, Ligament tears, Arthritis, Hysterctomy, etc
2 - 4 years
HDFC Ergo Energy Type-1 and Type -2 Diabetes, Hypertension 0 days
Care Supreme with instant cover add-on Cholesterol, BP, Asthma, Hypothyroid, Renal Calculus,
Gall bladder Stones, Ligament tears, Arthritis, Hypertension, Diabetes, Hysterectomy, BPH, etc
Min: 30 days
Max: 4 yrs
Care Advantage Cholesterol, BP, Asthma, Hypothyroid, Renal Calculus,
Gall bladder Stones, Ligament tears, Arthritis, Hypertension, Diabetes, Hysterectomy, BPH, etc
Min: 2 years (with add-on PED deduction)
Max: 4 years
ReAssure 2.0 with Add-On Cholesterol, BP, Asthma, Hypothyroid, Renal Calculus,
Gall bladder Stones, Ligament tears, Arthritis, Hypertension, Diabetes, Hysterectomy, BPH, etc
Min: 2 years
Max: 3 - 4 years
Health Enhanced Platinum with the disease management program Diabetes, Hypertension, Hyperlipidemia, and Asthma Min:2 years (Note: Wps are applicable only after clearing the eligibility criteria)

(P.S. You can also waive the waiting period for some specified pre-existing ailments with a health insurance add-on like Instant Cover from Care. Remember, the ultimate say lies with the Underwriting team.)