A pre-existing condition in health insurance is a medical condition or illness that a person has been diagnosed with or has received treatment for before they enroll in a health insurance plan. This can include chronic diseases such as diabetes, cancer, and heart disease, as well as conditions such as asthma, high blood pressure, and depression.
Similarly to other countries, having a pre-existing condition can affect the coverage and premiums of a health insurance plan in India. Some insurance companies may exclude coverage for pre-existing conditions or charge higher premiums to individuals with such conditions.
Also Read - USEFUL TIPS TO MAKE YOUR DIET HEALTHIER
However, the Insurance Regulatory and Development Authority of India (IRDAI) has issued guidelines stating that insurance companies cannot deny coverage to individuals with pre-existing conditions. Insurance companies are required to offer coverage for pre-existing conditions after a waiting period, typically ranging from 2 to 4 years. The waiting period may vary depending on the type of pre-existing condition and the specific insurance plan.
Why it makes sense to disclose your pre-existing condition
It is important to disclose your pre-existing disease when taking health insurance for several reasons:
• Accurate premium: Disclosing your pre-existing condition will ensure that your premium is calculated accurately. Insurance companies calculate premiums based on the likelihood of you making a claim, and if you have a pre-existing condition, you are more likely to make a claim in the future. Disclosing your condition ensures that your premium is calculated accurately and you are not underpaying or overpaying for your insurance.
• Full coverage: Insurance companies may exclude coverage for pre-existing conditions if they are not disclosed at the time of taking the policy. By disclosing your pre-existing condition, you ensure that you are aware of any exclusions or limitations in your policy, and you can take steps to obtain additional coverage if needed.
• Avoid rejection of claims: If you do not disclose your pre-existing condition at the time of taking the policy, the insurance company may reject your claim in the future if it is related to your pre-existing condition. By disclosing your condition, you avoid the risk of your claim being rejected due to non-disclosure.
• Legal requirement: In many countries, including India, it is a legal requirement to disclose pre-existing conditions when taking health insurance. Failure to do so may result in legal penalties or the cancellation of your policy.
Also Read - PROBIOTICS FOR WOMEN: HOW GOOD BACTERIA CAN SUPPORT FEMALE HEALTH
Tips to buy health insurance with pre existing illness
If you have a pre-existing illness and are looking to buy health insurance, here are some tips that can help you make an informed decision:
1) Research: Research different health insurance policies offered by various insurance companies. Make a list of your healthcare needs and requirements. Consider your pre-existing illness, any ongoing treatment or medication, and any potential future medical needs.
Identify insurance companies that offer health insurance policies in your area. You can use online insurance marketplaces or search engines to find insurance companies that offer health insurance policies.
Check the details of the health insurance policies offered by the insurance companies.
2) Compare policies: When comparing policies for pre-existing illness, here are some factors you should consider:
• Coverage for pre-existing illness: Look for policies that provide coverage for your pre-existing illness. Some policies may have a waiting period before providing coverage, so check the waiting period.
• Co-payments and deductibles: Check if the policy has any co-payment or deductible requirements. Co-payments are a percentage of the total cost that you must pay out of pocket, while deductibles are a fixed amount you must pay before the insurance company starts covering your expenses.
• Sum insured: Check the sum insured offered by the policy. The sum insured should be sufficient to cover your medical expenses in case of hospitalisation or treatment for your pre-existing condition.
• Premiums: Compare the premiums of various policies. Choose a policy that provides adequate coverage at an affordable premium.
• Network hospitals: Check if the policy has tie-ups with good network hospitals in your area and if those hospitals provide treatment for your pre-existing condition.
• Exclusions and limitations: Read the policy document carefully and understand the exclusions, limitations, and conditions of the policy. Make sure you are aware of any conditions or exclusions that may affect your coverage for your pre-existing condition.
• Waiting period: Check the waiting period for coverage of your pre-existing condition. Some policies may have a waiting period of up to 4 years before providing coverage for pre-existing conditions.
Also Read - A COMPREHENSIVE GUIDE TO CHOOSING THE BEST AND MOST AFFORDABLE HEALTH INSURANCE POLICY IN INDIA
3) Customer service: Here are some ways to check the reputation of a health insurance company:
• Check the insurance regulator's website: In India, the Insurance Regulatory and Development Authority of India (IRDAI) regulates the insurance industry. You can visit the IRDAI website to check the registration and financial status of the insurance company.
• Read customer reviews: Check customer reviews of the insurance company on online platforms such as Google, social media, or consumer forums. Reviews can provide insight into the quality of customer service and the claim settlement process of the insurance company.
• Check claim settlement ratio: The claim settlement ratio is the ratio of claims settled by the insurance company to the total claims received. A higher claim settlement ratio indicates that the insurance company settles a higher percentage of claims. You can find the claim settlement ratio of insurance companies on the IRDAI website.
• Check the financial stability of the insurance company: Check the financial stability of the insurance company by checking its financial ratings from independent credit ratings agencies such as CRISIL, ICRA, or CARE Ratings.
4) Disclose your pre-existing condition: Disclose your pre-existing condition when applying for health insurance. Failure to disclose your condition may lead to the rejection of your claim or the cancellation of your policy.
Also Read - FIVE POPULAR MONSOON HEALTH MYTHS BUSTED
5) Read the fine print: Read the policy document carefully and understand the exclusions, limitations, and conditions of the policy. Make sure you are aware of any co-payments, deductibles, or other out-of-pocket expenses that you may need to pay.
6) Seek expert advice: If you are unsure about which policy to choose or how to go about disclosing your pre-existing condition, seek advice from an insurance agent or financial advisor who specialises in health insurance.
You are still eligible to receive the advantages of a health insurance policy while having a pre-existing condition. To fully enjoy these advantages, you will need to pay higher premiums, nevertheless. Additionally, no pre-existing condition should be concealed while enrolled in a health insurance plan.
This can result in the denial of any claims submitted for that particular disease under the current insurance policy. Make sure you comprehend the terms and circumstances pertaining to the waiting period and the scope of insurance coverage in relation to pre-existing conditions.
While this can result in greater premium payments in the long term, it guarantees your security and peace of mind.
Also Read - TOP HEALTHIEST MONSOON FOODS
