Learn about the impact of pre-existing conditions in health insurance plans
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According to the National Family Health Survey of India (2019-20), diabetes, hypertension and obesity are the leading non-communicable diseases affecting the Indian population. Thus, opting for a health insurance plan amidst this wave of lifestyle diseases is no longer merely optional but mandatory. A good family health insurance plan offers comprehensive coverage against such ailments and conditions.
 
The same study also suggested that 1 in every 5 adults has elevated blood pressure, which increases the chances of suffering from cardiovascular diseases. Therefore, the rise in lifestyle ailments has been accompanied by a simultaneous increase in instances of chronic diseases like cancer and cardiovascular conditions. The financial burden of such conditions can be quite taxing on an individual without a health insurance plan.
 
While many want to opt for such family health insurance plans, several myths need to be debunked to create better awareness about mediclaim policies. This is specifically true for the pre-existing insurance cover. Most potential policy owners believe that medical insurance policies don’t cover pre-existing conditions, which deters them from purchasing the right plans or availing their entitled benefits. To understand this aspect of medical insurance plans, we must first analyse the insurer’s definition of a pre-existing condition.
 
What is considered a pre-existing condition?
The IRDAI changed the definition of a pre-existing ailment in 2020 to connote any injury, sickness, disease, or condition diagnosed in the insured individual at least 48 months prior to purchasing the health insurance plan. In other words, if you were not diagnosed with the condition that existed before you purchased the policy, it would not be classed under the pre-existing disease (PED) category, ensuring immediate coverage for such diseases without the usual PED waiting periods. This landmark amendment has greatly benefitted the policyholders, reducing the rates of claim rejections for those suffering from such pre-existing conditions.
 
Impact of PED on health insurance plans
Whether you’re buying a family health insurance plan or an individual one, you must be upfront with your policy provider about your PEDs. Non-disclosure or misinformation can lead to claim rejections and policy terminations. Here are the key ways in which PED affects your medical insurance policy:
 
Waiting periods - Health insurance plans with PED coverage come with a stipulated waiting period during which such coverage benefits remain out-of-bounds for the policyholder. In other words, no treatment or diagnostic costs related to the condition will be covered by the policy during this period. Depending on the policy provider, the individual's age, policy specifics and the type of disease, this period can range from a few months to a couple of years.
 
Padded premiums - Insurance companies view those with PEDs as higher liability clients than their non-PED counterparts. Thus, they charge a higher premium for insuring such individuals. The final premium amount after such risk padding will depend on the policyholder's age, type of medical condition, etc. Some insurance providers also offer a waiting period waiver against a high premium.
 
Exclusions and inclusions - The PED coverage of medical insurance policies varies. Thus, you must carefully review the policy documents to ensure that your PED is covered by the health insurance plan you purchase. While buying a family health insurance plan, you must ascertain that the policy covers the PEDs of all your family members.
 
Choice radius - It is important to note that Pre-Existing Diseases coverage – with or without waiting periods, is not a given with all medical insurance plans. Several family health insurance plans lack this crucial feature. Thus, when picking out policies, this can restrict your choice radius.
 
Policy termination - If there happens to be any discrepancy or misinformation about PEDs when purchasing a health insurance plan, the insurer reserves the right to reject your claim and terminate the plan.
 
Picking the right insurance plan with an adequate PED cover
 
To avoid being under-insured or facing claim rejection, opt for the online route when looking to choose a policy with PED coverage. You can compare medical insurance plans online on platforms like Bajaj Finance Limited and pick one that best fits your needs, budget, age, nature of diseases, etc.
 
Summary
The unpredictable nature of medical emergencies has driven the need to proactively secure the financial aspects of such situations with a comprehensive health insurance plan. The growing instances of lifestyle diseases and chronic conditions have pushed people to reconsider the salience of a medical insurance policy. PED coverage clauses in individual and family health insurance plans are important aspects to be considered when purchasing health insurance online, as they affect the coverage umbrella, premium costs, and overall claim settlement process.
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