Impact of pre-existing conditions on your health insurance

by Himani Mathur Content Writer

Buying health insurance plans for you or your family is a rather simple task, as long as you are able to provide clear details as required by the insurance documents. One of the things that require a mention at the time of buying the health insurance is the presence of pre-existing illnesses. This is a concept that may seem a little confusing. Many people understand pre-existing illnesses as any ailment or health condition that the insured is suffering from at the time of buying the policy. However, that’s not what it really is. The insurance company will also need to know the medical history of any illnesses and any hospitalizations that have occurred in the past. Hence, a heart attack or stroke years ago is also qualified information that needs to be disclosed.

How does any pre-existing condition impact the health insurance policy?

Depending on the kind of pre-existing health condition, insurance companies might be reluctant to give the health insurance policy, for the reason that the insured would be at a higher risk of a recurrence of the condition during the policy period. In order to leverage this risk, the health insurance company may include one of the following conditions in their health insurance plans:

Premium Loading

As the name suggests, this is a condition wherein the insurance company may ask for a higher premium than normal, in case the insurer has any kind of pre-existing health condition or ailment. This could include chronic ailments such as hypertension, diabetes, hearth related conditions, or even an accident history. In this case, the insurance company will load your premium at the time of buying the insurance policy. However, as per the Insurance Regulatory and Development Authority (IRDA), no insurance company can load the premium if the ailment or the condition is diagnosed after issuing the health insurance policy.

Waiting period

The health insurance company may include the clause of a waiting period when issuing health insurance to people with pre-existing conditions. The waiting period refers to the time period till when the insurance company will not be liable for any claims in relation to the pre-existing condition. For example, if appendicitis has been mentioned as a pre-existing condition, the insurance company may provide for a waiting period of 2 years from the date of buying the insurance policy, during which, the insurer will not receive any claims from the health insurance company for any conditions that may be directly related to appendicitis.

Permanent exclusion of pre-existing conditions

In some cases, when the pre-existing condition is found to be severe, the health insurance company may provide you the insurance coverage, exempting the condition. This implies that if you have severe diabetes, there could be a possibility that the insurance company will offer you the policy under the clause that all claims related to conditions that arise from diabetes and related illnesses will not be covered. This can leave the insurer with a higher risk of heavy expenditure, despite having health insurance coverage.

Policy denial

In case of severe pre-existing conditions, the health insurance company can deny health insurance coverage. This can usually happen with people who have a serious chronic ailment that can be dangerous to life, such as a medical history of more than two heart attacks.