Health insurance is a crucial aspect of our lives, providing us with the financial security and peace of mind we need when it comes to our health. However, for those with pre-existing conditions, health insurance can be a source of frustration and disappointment. In this article, we will explore the impact of pre-existing conditions on health insurance and how it can affect your faith in the system.
What is a Pre-Existing Illness?
A pre-existing condition is a health issue or illness that existed before you applied for health insurance. This can include chronic conditions such as diabetes, asthma, or heart disease, as well as previous injuries or surgeries. Essentially, any health issue that you have been diagnosed with or received treatment for before obtaining health insurance can be considered a pre-existing condition.
It includes the following:
Existing diseases and conditions including the signs/symptoms that the policyholder has acquired or is suffering from.
Prior hospitalization and surgeries.
Impact on Health Insurance Coverage
Having a pre-existing condition can significantly impact your health insurance coverage. Insurance companies may view individuals with pre-existing conditions as high-risk and may charge higher premiums or deny coverage altogether. This can make it challenging to find affordable health insurance, leaving many individuals with pre-existing conditions without coverage.
Challenges Faced by Individuals with Pre-Existing Conditions
Limited Options
Individuals with pre-existing conditions may still have limited options when it comes to health insurance. Some insurance companies may only offer plans with limited coverage or high premiums for those with pre-existing conditions. This can make it challenging to find a plan that meets their needs and budget.Changes in Coverage
Another challenge faced by individuals with pre-existing conditions is the potential for changes in coverage. Insurance companies may change their policies or coverage options, leaving individuals with pre-existing conditions without the coverage they need. This can be especially problematic if the individual's condition requires ongoing treatment or medication.Difficulty Switching Plans
For those with pre-existing conditions, switching health insurance plans can be a daunting task. Insurance companies may require individuals to disclose their pre-existing conditions and may deny coverage or charge higher premiums based on this information. This can make it challenging to switch to a more affordable or comprehensive plan.How Can One Buy a Health Insurance for their Parents Who have a Pre-Existing Illness?
If you are looking to buy health insurance for your parents who have a pre-existing illness, there are a few things you can do to ensure they are covered. Firstly, research and compare different insurance plans to find one that offers coverage for pre-existing conditions. You can also opt for a family floater plan, which covers the entire family under one policy. Additionally, you can consider purchasing a top-up or super top-up plan, which provides additional coverage for specific illnesses.
Frequently Asked Questions
Q. Do all health insurance companies offer coverage for pre existing diseases?
Yes, today almost all insurance companies offer coverage for pre-existing medical conditions. However, these conditions are covered only after a period of 2-4 years.
Q. What is the waiting period for PED?
The waiting period for pre-existing medical conditions is 2-4 years which may vary from insurer to insurer.
Q. Is high cholesterol a pre-existing medical condition?
Yes, high cholesterol and its associated conditions are considered to be pre existing under health insurance.
Q. Can insurance companies deny me coverage for pre-existing conditions?
No, insurance companies cannot deny coverage for pre-existing conditions. However, you can claim for the same only after a period of 2-4 years.
Q. Is it worth buying health insurance with waiting period/exclusions?
After knowing all of the above terms and conditions the most basic doubt would be if you would have any benefits of buying insurance after getting any ailment. The answer is still a resounding YES! You will still have benefits of having a policy.
Q. How can I go about buying a policy with pre-existing diseases?
Because in spite of the terms and conditions involved with pre-existing all the other ailments non-related ailments would be covered up to sum insured. Thus, you will get the full coverage for other hospitalization costs. Along with these your pre-existing would also be covered after the policy’s stated waiting period is over.
Q. Will congenital diseases fall under pre-existing diseases?
No. Congenital is the term used for diseases or physical abnormality that you have from your birth or which develops during neonatal stage of your life. Most common are congenital heart defects.
The insurance companies differentiate congenital diseases from pre-existing diseases while giving you a policy. With pre-existing conditions the chances of policy being rejected are lower than congenital diseases. Congenital conditions are permanently excluded by most of the policies. There may be a case where you have a congenital ailment, then, the insurance company may not give you a cover or chances of rejection increases.
Q. What does Pre-Existing medical condition mean?
A pre-existing condition is not only the term used for illnesses that a person has at the time of buying a policy but it also includes:
- Medical history of illness: History of heart attack, gestational diabetes, etc.
- Hospitalization history: Hospitalization in case of angioplasty, kidney stone, etc.
- Signs: Increase in sugar level, obesity, etc.
- Symptoms: Having brain fog, feeling sweaty, etc.
- Medication for any disease or illness: Hypertension medication, diabetes medication, etc.
- Skin disorder: Psoriasis, Vitiligo, etc.
- Major accidental injury: Head injury, having prosthetic limb, etc.
- Diagnosed illnesses: Diabetes, hypertension, etc. that you have or had before or at the time of buying a policy. Coming back to the reason why my friend's mother's Claim Was Rejected - She (the mother) was healthy at the time of buying the policy i.e. she neither had any illnesses or disorders at the time of buying a policy (person with completely normal test report). However, she was under medications for blood pressure. Eventually, it meant that her blood pressure was regulated by external medication which she failed to mention. Because of this her claim for something unrelated, in this case, the accident, was rejected. A health insurance company is less likely to issue a policy to an individual with lots of pre-existing conditions as these individuals are in greater need of medical cover which thereby increases the financial risk of the insurance company.
Q. Is there any health insurance that covers pre-existing conditions in India?
Yes, all health insurance companies provide policies which cover Pre-Existing conditions in India. This cover is not given immediately, all health policies come with a waiting period under ‘exclusions’ for any given pre-existing medical condition. This period varies from policy to policy. Under this period, any visit made to the doctor, hospitalization expenses, and medical care treatment bills will not be covered for these pre-existing conditions as per the policy.
Q. Is heart attack a Pre-Existing condition?
No, it is not a Pre-Existing condition as such an incident is unforeseen and can occur to any individual/child at any given stage of life. But, if you have been a patient of heart related ailments for a period of time and are prone to heart-attacks, provided there is written medical record/previous incidents and hospitalizations or undergoing treatment related to the heart, then, it will be declared as a pre-existing condition.
Q. Is anxiety a Pre-Existing medical condition?
Yes, anxiety is a mental disorder which increase the level of stressors with respect to any functional organ of the body. Anxiety itself is a major but indirect cause of serious mental as well as physical illnesses.
Q. Does a Pre-Existing condition have to be diagnosed?
Yes, you should never hide a Pre-Existing medical condition at the time of purchasing a health insurance policy. The best way is to undergo a medical check-up and get a complete picture of your health report. Failure to inform about Pre-Existing conditions to the health insurance provider can lead to claim rejection.
