When you decide to buy a health insurance policy, the first thing that comes to your mind is, “which diseases will I not be paid for”. In insurance terms, diseases that are generally not paid until a long waiting period, are called pre-existing diseases.
And when Pre-Existing Exclusion Clauses that have been off-and-on in the news in the last couple of years, keep coming up with various diseases that will not be paid for, it is pertinent that an Insurance buyer remains informed and updated.
But first thing first, what exactly makes up for a pre-existing disease?
Here’s the definition finalized by the Industry Body – General Insurance Council in India.
“the benefits (of health insurance) would not be available for any condition, ailment or injury or related condition for which the insured had signs or symptoms, and/or was diagnosed and/or received medical advice/treatment, prior to inception of the first policy, until 48 consecutive months of coverage have elapsed, after the date of inception of the first policy.”
While this definition may sound too simple, often insure persons misinterpret the definition and tend to mix up facts with myths. Hence, in this article, we list down the most common myths pertaining to pre-existing illness and make the picture clearer for you.
Most common myths surrounding pre-existing illnesses:
Only diabetes, is considered as a pre-existing disease
Diabetes is a pre-existing condition, but it is not the only one. There are a host of illnesses/diseases such as heart disease, kidney failure, paralysis, stroke, eye problems which have a greater propensity to have pre-existed, and which trace their root cause to either diabetes or hypertension or both.
All health insurance companies have a standard definition for pre-existing diseases
Different health insurance policies have different definitions for pre-existing diseases. According to some policies, a pre-existing disease is that which shows in a person’s past medical history. While other policies have a narrower definition that includes those diseases as pre-existing for which the insured person had sought consultation or was treated or was aware of the ailment during the last 4 years from the time he signs the proposal form.
Pre-existing diseases are never paid
Pre-existing diseases are paid, but after a period of maximum four years of buying the health insurance policy, even if a person is undergoing active treatment for such a disease. And even this is possible only if one continues with the health insurance policy with the same company for that period. Again, this differs from company to company and policy to policy, as, in some health policies pre-existing illness are covered after a waiting period of two years (a senior citizen policy for those above the age of 45). Generally, pre-existing diseases are covered after a waiting period of two to four years.
Changing a company, would mean the pre-existing waiting period is continued
It is true that after a waiting period of four years, as per the health insurance policy, pre-existing diseases are covered. However, if, on completion of two years, out of the four year waiting period, you move on to another health insurance company, then the waiting period of two years from the last company will not be counted. However, you need to find out whether the health insurance company from which you will buy the policy recognizes your track record of continuous coverage from another insurance company too. Some insist on continuous coverage only with them for this purpose.
I can hide my pre-existing disease
Firstly, it is important to understand just how the insurance company would know that a person has hidden his/her pre existing illness. When a person is hospitalized, he/she provides medical history to the doctor concerned, and this way the insurance company would know that you were suffering from a pre-existing disease and were aware of it, and yet, chose to not reveal it in the self declaration form. Then what happens is, not only will the insurance company not pay you the claim money for that particular hospitalization, but in case you get hospitalized due to something that has nothing to do with your pre existing disease, even then your claims will be rejected. This is because an insurance policy is an agreement of utmost faith. Hence, it is better to mention your pre-existing illness.
Pre-existing disease exclusions are for everyone
The pre-existing exclusions (including the 4 year waiting period) are for those who, at the time of signing the proposal form, have any signs or symptoms of any health condition, ailment, injury or who have been diagnosed for any health condition, ailment, injury etc. These ailments and injuries however, do not include, common cough, cold, fever etc. which are not long term and which do not have side effects.
This makes it clear that pre-existing illness waiting period is not for people who are hale and hearty, without any illnesses. Healthy people will be covered for all illnesses/conditions as are mentioned in the insurance policies.
Thumbs Up to all those who have taken health insurance!