Pre-existing conditions are conditions that the insured person has before purchasing a policy.
Some of the common examples of pre-existing conditions are diabetes, hypertension, kidney damage, certain cardiac conditions etc.
A few insurers cover pre-existing conditions subject to terms, conditions, limits and waiting periods. Some insurers also impose a co-payment clause for pre-existing conditions.
Correlation Between Risk and Premium
Insurance is the business of taking risks and that too at a profit. The insurance company needs to quantify the risk associated with each policy, and it can then calculate and offer you a premium accordingly. The higher the associated risk, the higher is the premium that an insurer has to offer.
Pre-Existing Conditions Indicate Greater Health Risk
If you have a condition, the chances of you claiming that condition increase. Hence, insurers charge a higher premium for the higher risk involved in covering you.
Pre-Medical Screening Tests
Some insurers facilitate pre-medical screening tests, while some mandate them. You should take the tests if your insurer offers you the option. The tests are performed to screen for pre-existing conditions.
If you have any pre-existing conditions, they will be detected and documented before purchasing the policy.
If you do not have any pre-existing conditions, that, too, will be documented before purchasing the policy.
In this case, both parties are well aware of the presence or absence of any pre-existing conditions. Claims can then be processed unambiguously based on this documented information.
Read about List of all the Pre-Existing Conditions in Health Insurance as per Age
Declaration and Disclosure before Purchasing Health Insurance
Some insurers do not mandate or facilitate pre-medical screening tests before purchasing a policy. Instead, they rely upon the declaration and the disclosure of information about pre-existing conditions by the insured.
Be Truthful in your Declaration and Disclosure
Some people state that they do not have certain pre-existing conditions despite having them. They think that their insurance might be rejected if they reveal their pre-existing conditions. Or they fear the imposition of higher premiums upon declaring pre-existing conditions.
When they make a claim later, the pre-existing condition may be revealed in a medical report. A medical report can state when the pre-existing condition was present with the insured person. This might lead to the rejection of the claim on the grounds of wrongful disclosure.
To avoid a situation like this, you should always be truthful in your disclosure and declaration.
Waiting Period for Pre-Existing Conditions Cover
Always come clean about your pre-existing conditions with the insurer.
Most insurers cover pre-existing conditions after a designated waiting period. Waiting periods are generally a few years. What it means is you are initially not covered for the pre-existing condition. After the lapse of the waiting period, you are covered. You will have to wait around till the waiting period lapses to be covered by most insurers.
Can you do something to be covered for the pre-existing condition during the waiting period? There might be some respite for a few corporate and government employees.
Read along to find out more.
Group Health Insurance Generally does not have Waiting Periods
Employees belonging to the corporate and government sectors benefit from group insurance, which is provided to them as an employee retention benefit.
Group insurance generally does not involve waiting periods. So, if you are covered by group insurance from your employer, you are in luck. You can use group insurance to cover the pre-existing conditions during the waiting period.
Co-payment Clause for Pre-Existing Conditions
Some insurers cover pre-existing conditions with a co-payment clause. What it means is, when you claim the conditions, you have to pay a certain fixed percentage of the claim amount, and the insurance company will pay for the rest.
Consider a case where the claim amount is ₹1 Lakh and the co-payment is 20%. Here you will have to pay ₹20 thousand, and the insurer will pay the rest of the ₹80 thousand.
Find the Appropriate Health Insurance Cover for your Pre-Existing Conditions
If you have pre-existing conditions, take heart. You do not have to shy away from health insurance altogether, and it can still be an effective tool to mitigate medical expenses.
Yes, the premiums might be higher, and there might be waiting periods and co-payment clauses involved. You have to work around and with these clauses.
Not all insurers treat all pre-existing conditions the same way. Look at all the available health insurance policies. Examine their conditions for covering pre-existing conditions. Pay special attention to their treatment of the pre-existing conditions that you have.
Zero in on the plan that covers your pre-existing conditions the best, and that is the most appropriate health insurance plan for you.
Read about Different Pre-Existing Conditions and Health Insurance