Pre-Existing Disease (PED) in Insurance

What is a Pre-existing disease?

Once you know the full-form, it sounds a lot simpler! PED stands for ‘Pre-existing Diseases’ or Pre-existing Condition, and is an important factor in your health insurance. It basically refers to the diseases or ailments you were suffering from at the time you bought your policy.

To be more precise, a “pre-existing disease” in insurance is any ailment you were suffering from, and diagnosed with, 48 months (or less) before you bought your insurance policy. PEDs can range from serious medical conditions like cancer or diabetes, to ailments like blood pressure or allergies.

So, imagine your doctor diagnoses you with asthma, and wrote you a prescription for asthma medication, and you buy insurance one year later. Then, your health condition – that is, asthma – is a pre-existing condition.

Why is it important to Declare Pre-existing disease?

You may be wondering if it’s worth declaring your pre-existing condition in the first place. But in this case, it’s best to be as transparent as possible!

Go through your medical files to ensure you have included all the diseases and treatments you would need to be covered. If you hide your pre-existing condition from your insurance provider and they find out about it later, forget waiting period, they may not cover it at all. So, it’s better to wait a while and get your PED covered than not declare it!

So, what are these waiting periods we were talking about? Well, there are actually a few different types. Let’s go through some of the most common ones:

Initial Waiting Period in Health Insurance

Every policy has an initial waiting period, usually about 30 days, but sometimes up to 90 days. 

During this time, no ailments will be covered, pre-existing or not. This waiting period only comes into effect once, when your policy first begins – it won’t recur every time you renew your policy. Some insurance policies may cover injuries from accidents during this time, but illnesses are generally not covered.

What is Pre-existing condition Waiting Period?

Most policies do include pre-existing condition insurance, but there is a waiting period of a few years before pre-existing condition is covered. The number of years depends on your age, and what the condition is. 

Specific Ailment Related Waiting Period

Don’t confuse this with the PED Waiting Period, which only applies to medical conditions that you already have. On the other hand, the Specific Ailment Related Waiting Period refers, as the name says, to specific ailments, such as diabetes, hypertension and hernia. These specific ailments are usually not covered for the first few years of the policy, after which they are covered.

What is Pre-existing Condition exclusion?

When due to pre-existing condition there are limits and restrictions on the health insurance claim, that's called as a Pre-existing condition exclusion.

What is Pre-existing condition waiver?

This is a benefit cover for pre-existing condition which waives off the exclusions and covers expenses that are related to hospitalization due to Pre-existing condition.

Read more: Learn more about the benefits of COVID 19 Insurance Policy

• Health Insurance policies differ from one another: And so do the terms and conditions with respect to pre-existing condition. You should always check for the waiting periods and the list of PED that are covered in your health insurance policy. 
• Not all ailments are considered as a pre-existing condition: Not all ailments or visits to the doctor are considered as a pre-existing condition. Insurers only consider medical conditions and ailments which have had a long-term effect on a person’s health. Other minor ailments and their side effects, like cough, cold, fever etc., do not determine a person’s health. 
• Hiding a Pre-existing Condition is never a good idea: We often think we should hide the facts that might hinder our chances of getting a health insurance, like a pre-existing condition. However, this can lead to a reverse effect, where even if you get a health insurance policy by hiding a PED, your claim might get rejected if the PED is found out later. So, it is always better to disclose a PED right at the start. 
  
• You can get coverage for Pre-existing Medical Conditions: We often think that PEDs cannot be covered. However various health insurers offer the benefit "Waiver of Pre-existing Condition", that covers PED and takes care of expenses related to it. 
  
• Waiver of Pre-existing Disease has a waiting period: For your health insurance policy to cover PEDs, often insurance companies have a waiting period of 2 years. So, you should start early with your health insurance policy. 
  
• Your health insurance provider may reject your claim if you have a pre-existing condition: But if you get a waiver of PED cover, your pre-existing conditions will also be covered in your policy. Most insurance providers have a 2-4 year waiting period for pre-existing condition. Which means that you’ll have to wait that long for your insurance provider to start covering your PED! 

In health insurance your pre-existing condition gets covered if you take the benefit that covers them too, like a waiver of pre-existing condition. So, remember to disclose all your pre-existing conditions to your health insurer. 

Before purchasing an insurance policy, it’s important to read the fine print, and find out how long each of these waiting periods are. And there’s some good news!

The Insurance Regulatory and Development Authority (IRDA) has approved health insurance portability. This means that in case you decide to change your insurance provider, you don’t have to go through the pre-existing condition waiting period all over again - you can carry it forward from one provider to another!