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An Overview of Health Insurance & Pre-Existing Health Conditions

Submitted by admin on May 25th, 2024

With complexities involved in health insurance, understanding the basics of insurance products could be difficult, and time-consuming but is highly important, especially if investors have pre-existing diseases (PEDs). For example, if you have been diagnosed with a disease and are planning to buy a policy that will address and accommodate your specific healthcare needs, it becomes more important to know how.

Through this blog post, we will cover PEDs and health insurance so that you will get to understand the implications of receiving a diagnosis shortly before or after buying a policy.

Pre-Existing Diseases in Health Insurance

As per the provisions of Guidelines on Standardisation of Exclusions in Health Insurance Contracts, PEDs refer to any condition, disease, ailment or injury for which an individual shows symptoms, signs, or received treatment within a particular period (usually 3 years)

How to Obtain a Health Insurance Product with Pre-Existing Medical Conditions?

For first-time buyers with pre-existing diseases or other medical conditions, here is what you should know to put your foot in the right place.

Research the insurance product: Carefully read all the terms and conditions of health insurance policies, review them, and explore the features as a part of your complete research about the products. It would be best if you were especially concerned about the specifics of the coverage, exclusions, waiting periods, and other relevant information.

Visit the website: Once a particular health insurance product appeals to you, visit the company for details. You must enter basic information such as your age, gender, location, and any coverage needs. The website will generate a premium quotation.

Personalize your insurance plan: Choose the insurance coverage, tenure, and riders specific to your plan. For example, the OPD rider, Critical Illness Rider, The Day 1 PED Coverage Rider, Global Cover Rider, etc

Fill out the insurance proposal form: Next you need to fill out the proposal form with the required information including your details, permanent and correspondence address, information of the nominee and family, etc. Potential buyers with pre-existing health conditions have to submit their medical records to the insurance company which will request email submission of the scanned copies of medical records or generate a link to upload the scanned photos.

Pay your premium online: Use a reliable payment method such as a debit card, credit card, UPI, net banking, or another option recognized by the insurance company, to pay your premium online.

Policy Decision: There are 3 important possible decisions:

Ø  Direct issuance

Ø  If there are PEDs

Ø  Counteroffer or rejection

How to Manage PEDs with Your Existing Health Insurance Product?

Imagine a nightmarish scenario. You have an insurance policy that acknowledges and fulfills your basic insurance needs. You have peace of mind that the policy will address your medical emergencies. Suddenly, you are diagnosed with a life-threatening disease such as cancer, heart attack, kidney failure, or a chronic illness like diabetes. It’s like a bolt from the blue and you’re in a fix about what to do.

Fortunately, most policies cover new diagnoses after they are in effect. Therefore, your existing policy will cover your new diagnosis, compensating you for your treatment cost, medication, and other required medical services.