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All about pre existing condition in a health policy

29 July, 2019

Rising healthcare cost in India has made it difficult for individuals belonging to the average income group to afford quality treatment. Thus, buying a health insurance policy has become an absolute necessity. An ideal health insurance policy that is Arogya Sanjeevani Policy will save you from the financial burden while undergoing a treatment procedure. Individuals who are young, healthy, and maintain a decent lifestyle can easily buy a health insurance policy without much hassle. However, getting a policy when you are already suffering from a pre-existing condition can be quite a task. Let us read in detail about the pre-existing condition in health policy.


What is a pre-existing condition?

If a person is suffering from any chronic medical condition or disease before buying a health insurance policy, such a condition is known as Pre-existing condition. From something as critical as diabetes, cancer to something less serious like high blood pressure, asthma, it can be any condition.


Individuals suffering from pre-existing conditions pose a higher financial risk for insurance companies. Thus, health insurance providers are hesitant in providing health policy to such individuals. Some providers may charge a higher amount of premium than the usual while some may include a number of underlying conditions before providing a policy to people with pre-existing illness.


Cover for Pre-existing illness

The insurance regulatory and development authority of India has made it compulsory for all insurance companies to provide protection against pre-existing conditions (Although, there is waiting period applicable). The general insurance council suggested a waiting period of up to 4 years before the cover for pre-existing conditions can begin. Insurance companies abide by this rule and mention a waiting period in the health insurance policy. However, the waiting period may vary from provider to provider. Also, this can be a determining factor for you when comparing different policies.


Declaration of Information

Conditions that was treated (or even cured) within 48 months (mostly) prior to the issuance of the policy must be declared to the insurance company. Even if the diagnosed condition was cured, it is safe to declare the same to the insurer in order to avoid rejection of the policy.


Ideally, the applicants declare their conditions beforehand as insurance is based on utmost good faith. If any undisclosed information related to your pre-existing condition is discovered at a later stage, it can lead to rejection of the claim.


Things you should know

If you are opting for a health insurance policy with a pre-existing condition, here is what you should know:


Every policy is different:

The terms on pre-existing condition may vary from policy to policy and provider to provider. Some providers may evaluate the entire medical history of the applicant while some may check only for a period dating back to 4 years. The waiting period may also vary according to the provider. When you are buying a policy with a pre-existing condition, ensure that you compare the waiting period for the coverage.


Premium loading

In some cases, the insurer may agree to provide protection against already existing illness, but the premium charges will be higher than the usual. This is known as premium loading.


Medical assessment

You are required to undergo a complete medical check-up before buying a health insurance policy. This is mostly after you have crossed a specific age. The illnesses diagnosed during this check-up will be considered as pre-existing conditions, and the same waiting period/premium loading will be applicable.



Not every small health issue will count as a pre-existing condition. Your frequent trip to doctor for minor ailments like fever, cold, flu, cough will not pose any trouble in your health insurance application.


Disclose the true information

In such cases, people might attempt to hide information related to pre-existing conditions. But it is not wise to do so. Even if you are successful in getting a policy, this may come forth at the time of your claim. And hiding important information can lead to rejection of claim or even cancellation of the policy.


Coverage for pre-existing condition

Many individuals with pre-existing conditions do not even think about approaching the insurance provider because they are under the impression that their application will be rejected. However, with a few exclusions and a waiting period, you can now get a health insurance policy with pre-existing conditions. For the duration of the waiting period, the insurer will not provide cover for treatment, medicine, or hospitalisation cost to the insured pertaining to pre-existing illness. The expenses can be claimed after the waiting period is over. However, insured can still claim expenses during the waiting period incurred due to other illnesses mentioned in the policy.




Can you be denied insurance for a pre-existing condition?

Not necessarily, it may vary depending upon the situation. Usually, there is a pre-specified waiting period for pre-existing conditions.  


What qualifies as a pre-existing condition?

Chronic health condition that is existing before you buy a health insurance policy is termed as a pre-existing condition. It does not include small conditions such as flu, cold, cough, etc.