pre-existing diseases in health insurance

What are Pre-Existing Diseases in Health Insurance?

Pre-Existing Diseases/PED is a term synonymous with health insurance. The term, if understood, can help you make an informed decision before purchasing the policy. So, we’ve put together this article to answer all of the questions you might have about this often-used phrase. From its role in policies, why it’s important to declare PED, to how Onsurity can assist you on the same.

What is a pre-existing disease?

A pre-existing condition/disease is defined as any injury, disease, or other medical condition that existed at the time before the effective date of enrollment of health insurance policy with an insurance company. To break it down – as the phrase suggests, pre-existing diseases are those that the person applying for health insurance, had before the date of purchase of the insurance.

Why is it important to declare pre-existing diseases?

According to our group health insurance partner ICICI Lombard’s survey, “Over 50% of policyholders are not sure whether they should disclose their PED ailments at policy inception. Around 30% feel they do not need to disclose pre-existing lifestyle diseases like diabetes and hypertension if they are under control”.

Just like any other policy, transparency in health insurance policies is established by disclosure of the policy terms and conditions. So, it’s important for the provider to clearly state the inclusions and exclusions of the policy. It is equally important for the customer to understand the terms of the purchased policy. Such transparency help in making informed decisions before purchasing the policy. It also helps the insurance partner understand their customer’s requirements better.

Why do we have pre-existing diseases in health insurance?

The reason for including PED in policies is to protect the policy holder’s medical conditions against the rising cost of healthcare. Lifestyle changes and with the spread of Covid-19, health issues are quickly rising among millennials as well. This means health insurance is no longer just for the older part of the population.

The policyholder needs to safeguard their health by opting for health insurance policies at an early age. An existing medical condition should not stop anyone from opting for a healthcare plan inclusive of health insurance. Most comprehensive health insurance policies define various illnesses and medical conditions under different categories in their policy.

What is the waiting period in a health insurance policy?

Generally, most of the health insurance policies have a waiting period associated with their health insurance plans. The main reason for having a waiting period is to avoid any anti-selection risk. This implies that the customer cannot apply for a claim immediately after buying a health insurance plan. The waiting period provision is created to safeguard insurers from fraudulent claims and focus on genuine claims.

In some cases, the waiting period for PED is waived off if provided by the insurance provider.

How are claims related to PED in health insurance policy?

The claim application usually goes through a verification based on the policy, plan, supporting documents, limits, etc. The policyholder needs to keep in mind the right time to apply for a valid claim. Many health insurance providers reject claims if there is a PED included. But, if the customer were to get a waiver on the PED cover, the specific illness can also be claimed.

The claim process is simplified on the Onsurity app with digital verification and approval system. Onsurity facilitates group health insurance for teams as part of its comprehensive healthcare plans. Users can also view our list of network hospitals and get personalized assistance during hospitalization on the app.

Here at Onsurity, we specialize in creating a cost-effective, comprehensive healthcare plan for organizations. To prioritize hospitalization and claim assistance for our customers, the “Good Doctor Team” came into being. Members of the team can also assist you in understanding the details of your policy.

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