Pre-existing conditions are a crucial factor in the health insurance industry in India. These conditions refer to any medical conditions or illnesses a person may have before purchasing a health insurance policy. These conditions can significantly impact an individual’s health insurance coverage, premium, and claim settlement process. Check out this blog to learn about the 8 roles pre-existing conditions play in health insurance coverage.
- Exclusions:
Pre-existing conditions are often excluded from the coverage of a health insurance policy. The insurance company may not cover any medical expenses incurred due to a pre-existing condition. For example, if a person has diabetes and purchases a health insurance policy, their policy may not cover any medical expenses related to their diabetes. Individuals with pre-existing conditions may be forced to pay for their medical costs out of pocket, which can be a significant disadvantage.
- Waiting periods:
Many health insurance policies have a waiting period for pre-existing conditions. This means an individual will have to wait for a specified number of years before they can claim medical expenses related to a pre-existing condition. The waiting period can vary from one policy to another, ranging from two to four years. For example, suppose a person has high blood pressure and purchases a health insurance policy with a four-year waiting period for pre-existing conditions. In that case, they will have to wait four years before claiming any medical expenses related to their high blood pressure.
- Premiums:
Pre-existing conditions can also affect the premium of a health insurance policy. Individuals with pre-existing conditions may have to pay higher premiums than those without pre-existing conditions. Insurance companies consider individuals with pre-existing conditions to be at a higher risk of incurring medical expenses. Hence, they charge higher premiums to compensate for this risk.
- Sub-limits:
Some health insurance policies may have sub-limits for pre-existing conditions. This means the insurance company will only cover certain medical expenses related to a pre-existing condition. For example, suppose a person has asthma and purchases a health insurance policy with a sub-limit of INR 1 lakh for pre-existing conditions. In that case, the insurance company will only cover up to INR 1 lakh of medical expenses related to their asthma. Any fees beyond this limit will have to be paid by the individual.
- Claim settlement:
Pre-existing conditions can also affect the claim settlement process. Insurance companies may ask for medical records and other documents to verify the existence and severity of a pre-existing condition before settling a claim. If the insurance company is satisfied with the documents, they may accept the claim or reduce the amount.
- Rejection of claims:
Insurance companies may only accept claims related to pre-existing conditions if they feel the individual has disclosed all the necessary information about their medical history. Individuals must be honest and transparent about their medical history when purchasing a health insurance policy to avoid any issues during the claim settlement process.
- Renewal of policies:
Pre-existing conditions can also affect the renewal of health insurance policies. Insurance companies may increase the premium or exclude specific requirements from a policy’s coverage during renewal. This can be a significant drawback for individuals with pre-existing conditions, as they may have to pay higher premiums or not be covered for certain medical expenses.
- Portability:
Pre-existing conditions can also impact the portability of health insurance policies. This refers to an individual’s ability to transfer their health insurance policy to another insurer without exclusions or waiting periods. Pre-existing conditions may not be covered under a new policy or may have a waiting period, depending on the terms and conditions.
In conclusion, pre-existing conditions play a significant role in health insurance in India. They can affect the coverage, premium, and claim settlement of a policy and may also impact the renewal and portability of a policy. Therefore, individuals must disclose all their pre-existing conditions while purchasing a health insurance policy to avoid issues during the claim settlement process.
It is also advisable for individuals to carefully review the terms and conditions of a health insurance policy before purchasing it to ensure that they are aware of any exclusions or waiting periods related to pre-existing conditions. By being proactive and informed about their health insurance coverage, individuals can ensure they have the necessary protection in case of any medical emergencies or illnesses.
