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How Do Pre-Existing Diseases Impact Your Health Insurance Policy?

If you are looking for health insurance, there might be quite a few questions that might need to be answered. One among which can be regarding pre-existing ailments and its impact on your insurance premiums. But before that, let us look at what is a pre-existing disease and why it should not be something that will stop you from getting a health insurance policy.

What are pre-existing diseases?

A medical condition or ailment that the policyholder is already facing at the time of purchase of insurance cover is defined as pre-existing disease. Insurance companies differently treat which ailments are included or specifically excluded otherwise, depending on the terms of the insurance policy. The regulator has amended the earlier definition of pre-existing diseases which caused a lot of ambiguity. The new definition now states that all medical conditions diagnosed or treatments which are recommended 48 months before purchasing the policy as a pre-existing condition.

Now that you know what are pre-existing diseases, here’s how it impacts the insurance premium.

Waiting period

Insurance companies cover pre-existing diseases but only after serving a specified waiting period. The waiting period is the duration up till which the insurance coverage doesn’t cover the specified ailment. For other ailments specified in your policy, the waiting period applies as per the standard terms of the policy, whereas pre-existing diseases might have waiting periods that range from 12 months to 36 months. This duration depends on the severity of risk that the insurance company has to assume and differs on case to case basis. These conditions are defined in your policy document. Whether you purchase an individual plan, family floater policy, or critical illness insurance, it is essential you make a note to avoid unpleasant surprises at time of claim.

Additional charge of premium

As stated above, pre-existing conditions are an added risk to your insurer. Thus, to include these ailments, the insurance company charges a slightly higher premium. This additional premium is only charged at its initial purchase and not at renewal date.

Premium loading along with a waiting period

In a few critical cases, the insurer may not only charge additional premium, but also apply a waiting period. A severe ailment that has a high mortality rate is generally subject to such treatment.

Medical check-up

Few insurance companies require individuals with pre-existing ailments to undergo a medical check-up. The results of these tests determine how much additional premium is to be charged. In some rare cases, where there is a high chance of mortality, insurers can also refuse coverage. Although it is an unusual case but should be known at the time of purchase of health covers.

While these are some effects of pre-existing diseases on insurance premiums, its impact can be checked by using the health insurance premium calculator tool. Pre-existing diseases should not be a deterrent for you to avoid a health cover, instead should make you more cautious while picking one. Note the impact it can have and make a suitable choice based on your healthcare needs.

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