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Ref. No. KLI/22-23/E-BB/492
Health insurance plans for pre-existing conditions outline strategies for obtaining suitable coverage, including understanding waiting periods and comparing policies.
When you suffer from chronic health conditions, the odds of medical emergencies increase. However, for this reason, insurers tend to avoid issuing health coverage to people with pre-existing medical conditions. Such diseases raise the probability of frequent health claims.
Fortunately, even with pre-existing conditions, you can get health insurance. However, the coverage is subject to specific conditions. Without the safety net of health insurance, how do you prevent the rising healthcare costs from affecting your savings? Awareness about the rules can help you find the right financial cushion for medical contingencies. The first step is to understand what pre-existing disease (PED) means.
A pre-existing disease is a medical condition that a person has been diagnosed with or has received treatment for before obtaining a new health insurance policy. These conditions can include chronic illnesses like diabetes, hypertension, heart disease, asthma, and other long-term ailments. Pre-existing conditions refer to any disease or injury you were diagnosed with or have undergone treatment in the 48 months preceding your health plan purchase date.
However, past medical treatments for minor health problems like seasonal flu or cold will not impact your access to a health plan. Only conditions that can lead to significant health complications are classified as PEDs. Some examples include diabetes, hypertension, heart attack, and other critical disorders.
This specialized insurance is designed to address the unique needs of those who require ongoing medical care, ensuring they receive comprehensive protection and peace of mind. Here are the key benefits of having pre-existing disease insurance:
One of the primary benefits of pre-existing disease insurance is financial protection. Medical treatments for chronic conditions can be costly, often requiring frequent doctor visits, medications, diagnostic tests, and hospitalizations. These expenses can quickly deplete your savings and strain your finances without insurance.
Medical debt can be overwhelming and challenging to manage, especially for those with ongoing health issues. Pre-existing disease insurance provides a safety net that helps prevent the accumulation of medical debt.
Chronic conditions often require continuous and consistent medical care to manage symptoms and prevent complications. Pre-existing disease insurance ensures you have access to the necessary treatments and medications without interruption. This continuous care is vital for maintaining your health and quality of life.
Pre-existing disease insurance provides holistic coverage encompassing various aspects of healthcare, from hospitalization and surgeries to outpatient consultations and diagnostic tests. This comprehensive approach ensures that all your medical needs related to the pre-existing condition are covered, offering peace of mind and security.
When applying for health insurance, it is crucial to understand how pre-existing conditions can impact your health plan. Here are the key effects of a pre-existing disease on your health insurance:
Premium loading refers to the increase in the premium amount due to the presence of a pre-existing disease. Insurers assess the risk of covering individuals with chronic conditions and often charge higher premiums to offset this risk.
Most health insurance policies include a waiting period for pre-existing diseases, a specified duration during which any claims related to the pre-existing condition are not covered. This waiting period typically ranges from one to four years, depending on the insurer and the specific condition.
In some cases, insurers may deny coverage altogether for individuals with certain pre-existing diseases, especially if the condition is severe or poses a high risk. Policy denial can occur during underwriting, where insurers evaluate the applicant’s medical history and current health status.
Insurers often combine premium loading and a waiting period for pre-existing conditions. While the policyholder faces higher premiums, they must also wait for a specified period before claims related to the pre-existing disease are covered.
Permanent exclusion is another way insurers handle pre-existing diseases. In this scenario, the insurer agrees to issue a policy but permanently excludes coverage for the pre-existing condition. The policy will never cover any medical expenses related to the excluded condition.
When applying for health insurance with a pre-existing disease, insurers often require a medical checkup as part of the underwriting process. The medical checkup helps insurers accurately assess the applicant’s health status and the severity of the pre-existing condition. The results of this checkup influence the insurer’s decision regarding premium loading, waiting periods, or exclusions.
Pre-existing conditions can complicate securing insurance, but by evaluating key factors, you can find a policy that best suits your needs. Here are the crucial factors to consider:
The waiting period is when claims related to pre-existing diseases are not covered by the insurance policy. This period typically ranges from one to four years, depending on the insurer and the specific condition. When comparing policies, look for those with the shortest waiting periods. A shorter waiting period ensures you can access coverage for your pre-existing condition sooner, reducing out-of-pocket expenses during the interim.
Understanding the extent of coverage and any exclusions is vital. Some policies may offer comprehensive coverage for pre-existing diseases after the waiting period, while others may have permanent exclusions for certain conditions. Review the policy details to ensure your pre-existing condition’s specific needs are adequately covered. Pay attention to any exclusions or limitations affecting access to necessary treatments and medications.
Opt for policies that offer lifelong renewability, ensuring you continue receiving coverage as you age. Policies with limited renewability could leave you without coverage when you need it the most. Lifelong renewability provides peace of mind and guarantees continuous protection against medical expenses.
The claim settlement ratio represents the percentage of claims settled by the insurer out of the total claims received and is a key indicator of an insurance company’s reliability and efficiency in processing claims. A higher claim settlement ratio indicates a better track record of approving and paying out claims. When selecting a policy, choose an insurer with a high claim settlement ratio to increase the likelihood of your claims being settled promptly and without hassle.
Pre and post-hospitalization coverage refers to the expenses incurred before and after hospitalization, such as diagnostic tests, doctor consultations, and follow-up treatments. These costs can add up significantly, especially for chronic conditions. Ensure that the health insurance policy provides adequate coverage for pre and post-hospitalization expenses, as this comprehensive coverage is essential for managing pre-existing diseases effectively.
Customer reviews and feedback provide valuable insights into policyholders’ real-world experiences. Researching customer feedback can help you gauge the quality of service, claim settlement process, and overall satisfaction with the insurer. Look for reviews on independent platforms and consider positive and negative feedback for a balanced perspective. Choosing an insurer with positive customer reviews can improve your overall experience and ensure better support when needed.
While many insurers have strict guidelines regarding pre-existing conditions, there are strategies and steps you can take to improve your chances of obtaining suitable coverage.
Premiums and availability of health insurance depend on your medical history. But, to avoid rejecting your health cover application or hefty premiums, do not provide inaccurate details to your insurer. Claim settlement requires treatment details. Your current treatments can depend on your past medical history. Thus, your treatment details may record your past medical problems. Therefore, your insurance provider will discover your PED. They can decline payouts if they find out that you have suppressed facts.
Many health insurance policies cover PEDs after a gap of two to four years called the ‘waiting period.’ During this phase, you cannot raise claims for treatments, medical bills, or doctors’ fees for your PEDs. However, your insurer will settle claims for other medical expenses covered by your policy.
Diabetes increases the risk of heart disease and liver damage. High blood cholesterol levels, hypertension, and diabetes also increase the risk of stroke and heart problems.
Hence, a history of high blood pressure, elevated blood sugar and cholesterol levels, and similar lifestyle disorders makes critical illness insurance essential. Ailments like heart attack, stroke, and liver cirrhosis can result from PEDs. These disorders often require expensive long-term treatments. The costs of quality healthcare can lead to debts or the sale of assets, disrupting your financial stability.
Following these do’s and avoiding the corresponding don’ts can help individuals effectively manage pre-existing conditions with the right health insurance coverage, ensuring financial protection and access to necessary medical care.
| Do’s |
Don’ts |
| Disclose all pre-existing conditions honestly |
Do not conceal or misrepresent your medical history |
| Compare multiple health insurance policies |
Do not settle for the first policy you find |
| Understand waiting periods and coverage details |
Do not overlook policy exclusions and limitations |
| Opt for policies with shorter waiting periods |
Do not assume all insurers treat pre-existing conditions equally |
| Consider specialized health plans if available |
Do not delay in purchasing health insurance |
| Consult with an insurance advisor if needed |
Do not forget to update your policy as needed |
| Maintain a healthy lifestyle and regular check-ups |
Do not ignore preventive care and wellness programs |
Exploring health insurance for pre-existing conditions requires careful consideration of policy terms. By understanding your health needs, comparing plans, and selecting the right policy, you can secure comprehensive coverage that provides financial protection and access to essential healthcare services. Stay informed about policy changes, communicate openly with your insurer, and prioritize your health and well-being through proactive insurance planning.
1
Health insurance companies may be cautious about pre-existing diseases because they increase the risk of frequent claims and higher medical costs, which can impact profitability. Insurers assess these risks through underwriting processes to manage their financial exposure effectively.
2
The waiting period for pre-existing diseases typically ranges from 1 to 4 years, depending on the insurer and policy. During this period, the health insurance policy does not cover any claims related to pre-existing conditions.
3
Yes, health insurance companies in India have the right to deny coverage or impose exclusions for pre-existing conditions based on their underwriting guidelines. However, insurers must disclose these terms upfront during the policy application process.
4
A higher claim settlement ratio indicates an insurer efficiently processes and pays out claims. A high claim settlement ratio is crucial for individuals with pre-existing conditions as it signifies the insurer’s reliability in honoring claims related to chronic illnesses and medical treatments.
5
Insurance for pre-existing conditions ensures continuous care by covering ongoing medical treatments, medications, and hospitalizations. It helps manage health expenses, encourages regular check-ups, and ensures access to necessary healthcare services without financial strain. This continuity of coverage is essential for managing chronic conditions effectively over time.
Amit Raje is an experienced marketer who has worked in various Fintechs and leading Financial companies in India. With focused experience in Digital, Amit has pioneered multiple digital commerce in India. Now, close to two decades later, he is the vice president and head of the D2C business department. He masters the skill of strategic management, also being certified in it from IIMA. He has challenged his challenges and contributed his efforts in this journey of digital transformation.
Prasad Pimple has a decade-long experience in the Life insurance sector and as EVP, Kotak Life heads Digital Business. He is responsible for developing user friendly product journeys, creating consumer awareness and helping consumers in identifying need for life insurance solutions. He has 20+ years of experience in creating and building business verticals across Insurance, Telecom and Banking sectors
Ref. No. KLI/22-23/E-BB/2435
The information herein is meant only for general reading purposes and the views being expressed only constitute opinions and therefore cannot be considered as guidelines, recommendations or as a professional guide for the readers. The content has been prepared on the basis of publicly available information, internally developed data and other sources believed to be reliable. Recipients of this information are advised to rely on their own analysis, interpretations & investigations. Readers are also advised to seek independent professional advice in order to arrive at an informed investment decision. Further customer is the advised to go through the sales brochure before conducting any sale. Above illustrations are only for understanding, it is not directly or indirectly related to the performance of any product or plans of Kotak Life.
