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Pre-Existing Disease Health Insurance

Nowadays, individuals complain of health issues even at a very young age. The reasons are lifestyle habits, lack of exercise, erratic eating habits, and many more. A healthy Body Mass Index can help avoid these issues. ...Read More

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Pre-Existing Disease Health Insurance

What is a Pre-existing Illness?

Pre-Existing Disease Health Insurance
April 04, 2025

Table of Content

 

Any health condition, such as high blood pressure, diabetes, thyroid, asthma, etc., diagnosed before opting for medical condition insurance coverage is a pre-existing illness. If you have these issues four years before purchasing the insurance plan, they are considered pre-existing and will be covered after a waiting period ranging from two to three years.

Waiting Period for Pre-existing Diseases

The expenses incurred for pre-existing disease-related health conditions are not covered from day 1 of purchasing health insurance plans. It is covered after a defined period from the date of policy purchase. Details of varied waiting periods are given below:

  • Initial Waiting Period

The initial waiting period in health insurance applies to all policyholders even if they do not have pre-existing illnesses. Generally, it is 30 days from the policy issuance date. Claims are not entertained during this period.

  • Pre-Existing Disease Waiting Period

This is the waiting period specified for covering pre-existing illness-related health issues. It depends on the insurance company and is normally two to three years from the policy issuance date. You can opt for a pre existing waiting period waiver as an add-on to the base plan for an extra premium.

  • Waiting Periods for Specific Diseases

Some pre existing disease health insurance plans have select waiting periods for specific diseases such as kidney failure, heart disease, stroke, or other diseases mentioned in the plan.

  • Factors Affecting Waiting Periods

The factors that affect the waiting periods for health insurance with pre existing conditions are age, nature of the pre-existing illness, insurance company, location, plan selected. .

  • Shorter Waiting Periods

Some insurance companies are now offering coverage for pre-existing illnesses within one to two years instead of two to three years to expedite the coverage availability.

  • Transferability

With the portability of health insurance for pre-existing disease available, you can now switch to a new insurer while retaining the benefit of the completed waiting period.

  • Insurance Costs

The health insurance premium for chronic diseases depends on the extent of the waiting period for pre-existing diseases. You can pay a higher premium and opt for immediate coverage or a shorter waiting period while purchasing a pre-existing disease insurance plan.

How a Pre-existing Disease Affects Your Health Insurance

The impact of pre-existing diseases on your health insurance is as mentioned below:

  • Premium Loading

Considering the risk involved in covering pre-existing diseases, the insurance companies charge a higher premium for a health policy for existing diseases. The premium loading is done at the time of policy purchase and will remain unchanged if renewed periodically without a break.

  • Waiting Period

The period from the policy date till the start of coverage is the waiting period there is no definite waiting period. It depends on the service provider, the terms of the plan you purchase, and the nature of the illness. For instance, the waiting period for covering cardiac issues may be different from that for hypertension-related health issues. It can be between 2 and 3 years.

  • Premium Loading + Waiting Period

Sometimes, you might have to pay a higher premium and also wait for a longer period to get coverage for pre-existing illnesses. This applies to the waiting period for chronic illnesses such as high blood pressure, diabetes, etc.

  • Medical Check-up

When you disclose pre-existing illnesses, the insurance company might insist on a medical check-up. The premium loading depends on the test results. At times, the insurer may refuse to issue a policy if the outcome of the medical check-up is not favourable.

  • Permanent Exclusion

You should be aware of policy exclusion for pre-existing illnesses before buying in a plan. It means some of the pre-existing illnesses might be permanently excluded from the plan and not covered even with a waiting period. You will have coverage for any other health conditions apart from the pre-existing illness eliminated from coverage.

Why Do Health Insurance Companies Avoid Covering Pre-Existing Diseases?

Insurance companies hesitate to issue insurance policies to individuals with pre-existing diseases as they are more susceptible to developing health complications in the future.  The insurer might have to bear huge medical costs as these individuals may require frequent medical attention. Considering the financial risk involved, service providers avoid covering pre-existing diseases.

However, to mitigate this risk, insurance companies may charge higher premiums, impose exclusions, or even reject the health insurance application. Insurance companies exercise maximum caution while issuing a pre existing disease health insurance plan.

Tips for Buying Health Insurance with a Pre-existing Disease

After understanding what is pre existing disease in health insurance, you should also know how to get the best deal in spite of having pre-existing illnesses. Follow the tips given below to get the most from the plan.

  • Pre-existing Disease Coverage is Available After 36 Months

Persons with pre-existing diseases find it hard to get covered under pre existing disease health insurance. Keeping this in mind the regulatory has issued guidelines that insurance companies should consider the medical history for the past 36 months only to detect any pre-existing disease. This enables health insurance coverage after four years of being diagnosed with any pre-existing disease.

  • Be Honest About Your Pre-existing Illness

Being honest about pre-existing illnesses while applying for pre existing disease health insurance has several advantages. Disclosure of your health condition will help in a seamless claim settlement. If you suppress facts and they are detected during the treatment, the insurance company may deny the insurance claim for pre-existing conditions.

  • Not Every Doctor Visit is Considered a Pre-existing Disease

Suppose you visit a doctor frequently to get treated for issues that do not impact your long-term health. A doctor visit for treatment of a cold or fever is not considered pre existing disease in health insurance. Only treatments for issues like high blood pressure, diabetes, etc., are viewed seriously as they may cause major health complications in the future that may need expensive treatments.

  • Choose a Health Plan with a Shorter PED Waiting Period

Compare medical insurance for pre existing conditions from different insurers and choose the one with a shorter pre-existing disease waiting period. You do this exercise irrespective of whether it is an individual policy or a family floater.

  • Avoid Health Plans with Co-Payment for Pre-Existing Disease Coverage

Some health insurance for pre-existing conditions imposes co-payments for pre-existing diseases. If you choose a plan with this condition, you will have to bear a defined percentage of the treatment cost which enhances your out-of-pocket expenses. Always compare plans and select a plan with no co-payment.

Why It's Important to Disclose Pre-Existing Conditions?

It is important to disclose pre-existing conditions while applying for health insurance for pre existing disease for the following reasons:

  • To Avoid Claim Rejections

If you do not disclose pre-existing diseases during the policy purchase, the insurance company can reject a claim and deny further financial protection.

  • To Determine Accurate Premiums

If you disclose pre-existing diseases while applying for a health insurance plan, premium loading for pre-existing conditions is done depending on the risk involved and helps in determining accurate premiums.

  • To Initiate Waiting Periods

The waiting period is initiated from day 1 if you disclose pre-existing illnesses, and the coverage will begin as soon as the waiting period is completed.

  • Review Inclusions/Exclusions

Being transparent about your existing health condition while applying for health insurance with pre existing conditions helps you make an informed decision. The insurance company will inform you if a particular pre-existing condition is eligible for coverage or not.

  • To Prevent Future Disputes

A waiting period is stipulated for pre-existing illness coverage. Mentioning pre-existing conditions while applying for a health plan amounts to transparency and prevents future disputes.

  • Portability Benefits

You can retain the accumulated waiting period when you switch the pre existing disease health insurance to another insurance company.

  • Understand Limitations

You will understand the deductibles and the caps stipulated for particular conditions, and this will help you make an informed decision.

Understanding Health Insurance with Pre-Existing Conditions

Understanding what is pre existing disease in health insurance to make the right decision while buying a pre existing disease health insurance. You should also be aware of the various aspects mentioned below to get appropriate coverage.

  • Being Honest is Important

Mention every detail about your medical history, the test results, chronic disease, etc., in your application for pre existing disease health insurance. Disclosure of prevailing health issues will avoid claim rejections in the future.

  • Insurance Terms Can Vary

Insurance companies have different rules for medical tests, inclusions, exclusions, caps on specific conditions, waiting periods etc., for providing coverage for pre-existing illnesses.

  • You're Likely to Pay Higher Premiums

Since the financial risk is higher, the premiums are also higher to provide coverage for pre-existing illnesses.  Your age, health condition, and pre-existing diseases are the deciding factors for premium allocation.

  • Some Plans Do Not Cover Pre-existing Diseases

The plan that aligns with your requirements and budget may not cover pre-existing diseases. Read the terms of the plan before selecting.

  • Keep Your Coverage Ongoing

Renew your policy regularly for ongoing coverage. This will provide the benefit of carrying over the accrued waiting period if you plan to switch insurers.

  • Choose the Right Sum Insured for Your Needs

Choose the right sum insured depending on the pre-existing condition and the anticipated health complications for coverage to meet your requirements now and in the future.

How to Buy Health Insurance for Parents with a Pre-Existing Illness?

It is recommended to buy pre existing disease health insurance early in life as it may be difficult to get coverage as you age. The steps to buy health insurance for parents with a pre-existing illness are given below:

  • Step 1

You have both offline and online options to purchase health insurance for parents with pre-existing illnesses.

  • Step 2

Undergoing medical tests if the insurance company insists.

  • Step 3

The underwriting team will review the test results and inform you about the status

  • Step 4

The insurance company may charge a higher premium or may reject coverage.

Pre-Existing Diseases: Do's and Don'ts

The do’s and don’ts for pre existing disease insurance are:

  • Get a Health Check-up

Get a medical check-up done to detect pre-existing health issues and take steps to keep them at bay at the initial stage.

  • Don't Hide Information

Be transparent about your medical history while applying for a health insurance plan.

Always Compare Plans Before Buying

Compare plans offered by different service providers for an informed decision.

Summary

Getting in a pre-existing disease insurance plan is crucial if you have a family history of conditions like hypertension or diabetes or are at risk due to lifestyle habits. Being transparent about your medical history and pre-existing conditions ensures a smoother claim process when facing high medical expenses. Additionally, life insurance plays a vital role in financial security, especially for individuals with pre-existing illnesses. It ensures that your loved ones are financially protected in case of an unfortunate event, offering peace of mind and long-term stability. Combining health and life insurance is the best strategy to safeguard both your healthcare needs and your family's financial future.

FAQs on Pre-existing Disease Health Insurance

Q. How are pre-existing conditions determined?

The pre-existing conditions are determined by the diagnosis and treatment received for an illness before purchasing a plan. It is also detected with medical tests done on applying for policy.

Q. Does a pre-existing illness have any impact on the amount of coverage?

Pre-existing illnesses do not affect the sum assured. The insurance company may charge a higher premium and stipulate a waiting period to provide coverage for the illnesses.

Q. What are pre-existing diseases (PED) in health insurance?

A medical condition diagnosed before the policy purchase is considered a pre existing disease in health insurance.

Q. What is the waiting period for pre-existing disease in health insurance?

The interval between the policy purchase date and the coverage commencement for specific illnesses is the waiting period.

Q. Can I be denied health insurance because of a pre-existing condition in India?

No. Health insurance cannot be denied because of pre-existing conditions in India. However, insurance companies can collect higher premiums and stipulate waiting periods to cover the conditions.

Q. What is a pre-existing disease before 36 months?

Pre-existing disease is any condition, ailment, injury or disease, which is diagnosed or for which medical advice or treatment was recommended by, or received from, a physician, not more than 36 months prior to the date of commencement of the policy.

Q. What is a serious pre-existing condition?

A serious pre-existing condition is a chronic illness existing before the policy purchase and requiring ongoing treatment.

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Francis Rodrigues Francis Rodrigues

Francis Rodrigues has a decade long experience in the insurance sector, and as SVP, E-Commerce and Digital Marketing, HDFC Life, manages the online sales channel, as well as digital and performance marketing. He has had hands-on experience in setting up sales channels and functional teams from scratch over a career spanning 2 decades.

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Vishal Subharwal Vishal Subharwal

Vishal Subharwal heads the Strategy, Marketing, E-Commerce, Digital Business & Sustainability initiatives at HDFC Life. He is responsible for crafting and ensuring successful implementation of the overall organisation strategy.

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