Pre Existing Disease Health Insurance Plans

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.” Hence, in this article, we will discuss everything one needs to know about pre-existing diseases, and the plans that cover it.

Note: This is a general list, but coverage depends on a case-to-case basis. Assumption: 30-year Old Male | Zone 1 | 1 Benign PED

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?

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: This plan 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: This plan 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:

• Not all health insurance policies cover pre-existing diseases: Most health insurance plans impose waiting periods for pre-existing diseases (PEDs), while some may permanently exclude severe conditions like advanced heart disease or cancer. That’s why reading the policy wording carefully is important.
• Pre-existing diseases increase the cost of your premiums: PEDs are considered higher risk, so insurers may charge higher premiums through loadings. Some policies may also include co-payment clauses, where you pay a part of the treatment cost yourself.
• Health insurers may reject your policy based on the PED: For severe or multiple health conditions, insurers may reject the application altogether. Always disclose your complete medical history honestly, as hiding information can lead to claim rejection or policy cancellation later.

Why Choose Ditto for Health Insurance?

At Ditto, we’ve assisted over 8,00,000 customers with choosing the right insurance policy. Why customers like Pallavi below love us:

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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.