Dispelling some myths about health insurance coverage for pre-existing conditions

New Delhi: The recent COVID-19 pandemic is a stark reminder that having a solid health insurance plan with adequate coverage is no longer an option, but a necessity. With rising medical costs and an increased risk of infection, it is prudent to have financial protection against unexpected medical expenses. However, as one’s age increases, obtaining coverage becomes more difficult and expensive, especially if one is already ill.

It is a common misconception that if a person has a pre-existing condition, they may be denied health insurance altogether. Even if they are able to obtain a policy from a reputable insurer, they believe the scope of coverage will be insufficient to cover their hospitalisation costs, especially if the reason for hospitalisation is related to a pre-existing condition.

On the one hand, this leads to a large number of people foregoing health insurance altogether. When purchasing a health plan, people, on the other hand, end up concealing their pre-existing conditions. Both of these options have the potential to be disastrous for the individual. While they would have to pay the entire hospital bill out of pocket if they did not have coverage, failing to disclose the true state of their health when purchasing a policy may result in their claim being outright rejected.

Health insurance coverage for pre-existing illnesses

To begin with, every insurer provides health insurance policies to people who have pre-existing conditions. The only catch is that there is a waiting period before coverage for that specific pre-existing condition begins. During this time, the policyholder is not eligible to make a claim for hospitalisation due to a pre-existing illness. This also applies to doctor fees and the cost of medications that may be required on an ongoing basis.

For example, if a diabetic person purchases a policy, he or she will be covered for all illnesses except diabetes as soon as the policy kicks in, which is usually 30 days after the policy is purchased. Diabetes coverage, on the other hand, begins after a waiting period specified in the policy document, which can range from two to four years. Instead of concealing the policyholder's health status at the time of purchase, which may cause complications when filing a claim, the policyholder should simply declare the pre-existing disease and enjoy coverage against it, albeit after a waiting period.

If the exclusion of pre-existing ailments during the waiting period still concerns you, the good news is that many insurers have developed specially designed plans that offer coverage against pre-existing diseases from day one, or with a waiting period as short as one to three months. This means that even those with pre-existing conditions such as hypertension, asthma, diabetes, or high cholesterol levels can purchase a Pre-Existing Disease (PED) policy, which begins protecting them as soon as they purchase the policy.

While the option to reduce the waiting period for pre-existing diseases existed previously, with relaxed underwriting norms, it has become much more affordable. According to industry estimates, these plans are 40 per cent less expensive than previous variants.

Choosing the right health insurance policy

Because the rules, terms, and conditions of different insurers' health insurance plans differ, it is prudent to compare multiple plans and their treatment for pre-existing conditions. You can then narrow it down to a plan that is specific to your needs. The good news is that, thanks to the digital revolution of the last decade or so, comparing plans offered by different insurers online has become very simple.

When comparing plans, look for the waiting period for pre-existing conditions. Before purchasing the policy, find out if any medical tests are required. Once you've chosen a plan, check to see if you can reduce the waiting period even further by paying an additional premium, or if it includes optional PED coverage. If so, how much does it cost, and how long does it take to get there?

Most importantly, make sure to clearly specify any pre-existing conditions when purchasing the policy. A pre-existing illness, according to the Insurance Regulatory and Development Authority of India's (IRDAI) new definition, is a medical condition, sickness, disease, or injury that has been diagnosed in the insured person by a physician prior to the purchase of a medical insurance plan. Customers should report any childhood surgeries or heart conditions that occurred before the age of seven. This is advised because underwriting is based on such criteria. As a result, any medical history, whether it’s surgery, COVID-19, or any ailment that has occurred in one's lifetime, should be disclosed. This is done to ensure that claims are paid and not rejected due to PED non-disclosure.

So, whether you are healthy or have a pre-existing condition, you should get yourself covered by a health insurance policy as soon as possible. It all comes down to being informed and selecting the policy that is best suited to your specific needs.