On October 28, 2011

Health Insurance claims deniedAs in today’s life style when there is lack of physical activities and imbalance diet most of the people are suffering with one or the other diseases such as diabetes, hyper tension, heart related diseases etc; hence it has become imperative to have a health insurance because health care expenses are increasing day by day. But, can you get health cover for pre-existing diseases?

As per Insurance Regulatory and Development Authority (IRDA) insurance companies will have to cover people who are suffering from pre-existing diseases after waiting period; however, insurers can charge additional premium for known diseases.

Pre-existing diseases are those known ailment, medical condition or injury that one has suffered during last 48 months prior to taking a health insurance policy. Pre-existing disease not only includes critical illnesses but it also cover diseases such as hyper tension, asthma, diabetes or any injury.

Earlier due to the ambiguity in the definition in the pre-existing disease insurers used this ground to reject claim. Hence, to stop malpractice and offer uniformity in the health insurance policies statuary body of non-life insurers General Insurance Council (GIC) has come out with uniform definition of pre-existing disease according to which benefits of health insurance policies will not be available for any ailment, medical condition or injury or related condition for which insured had signs or symptoms or he has diagnosed with it or received treatment before taking the first health insurance policy until 48 consecutive months of coverage has lapsed after the inception of the first policy. GIC also said that all policies issued from first June 2008 will cover pre-existing diseases after five years.

It is advisable for policyholder that he should completely disclose his medical facts or it is even better that he should go thorough medical test before taking a health cover so insurer is fully aware of your medical condition before providing you health cover so that he can not reject claim on ground of any pre-existing disease; as most of the claims are rejected on the ground of hiding pre-existing disease. On the time of claim if you are found with any pre-existing disease then Insurance companies insist that policyholder intentionally did not disclose his condition but sometimes case may be different as policyholder was not aware of the disease or his agent dissuade him not to disclose saying that his policy may get rejected.

And if you are suffering from any pre-existing disease then insurer can charge you extra premium or he can even exclude that disease.

Insurance companies are not comfortable to provide health cover to those who are suffering from pre-existing diseases because there is high risk of claim.

Insurance cover for pre-existing disease starts after waiting period is over without any break in the policy. Waiting period is the period after which coverage starts; waiting period may be between 2-4 years depending on the insurance company and depending on the ailment. Take for instance at the time of buying of the health cover you are suffering from any pre-existing disease then you can not file claim for that disease during the waiting period however, you can file claim for the same disease after the waiting period is over.

Some insurance companies provide partial cover for pre-existing diseases but instead of that policyholder should prefer paying little more premiums for full cover. Hence go through the fine print of the terms and conditions of the policy.

And after buying policy you are not satisfied with the terms of the policy you can return the policy within free look period of 15 days and your premium will be refunded.

It is also necessary to check exclusions in the policy; as cataract, hernia, piles, arthritis, sinusitis is generally excluded in the first year of the policy. Most of the pre-existing life threatening diseases are covered after four years. If insurer is covering pre-existing diseases then related ailments are also covered.

Under health insurance portability waiting period of pre-existing diseases is also carried forward. Take for instance if there is waiting period of two years and if you are porting your health insurance policy to another insurer than also waiting period will remain same.

Some insurers can reject cover for pre-existing diseases citing them as permanent exclusion.

Group health insurance policies cover pre-existing diseases from first year itself.

However, some group health insurance policies has co-pay clause that means insured will have to share some part of the claim with insurance company.

Travel insurance policy generally does not cover pre-existing diseases.

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