Ram took a health insurance policy for his father. While filling the proposal form, he witnessed a column asking about the pre-existing diseases. Since there was no sustained medical condition, he put a cross at that. After 2 years of continuous renewal, his father got hospitalised and insurance company denied the claim on the basis of non disclosure of the pre-existing condition.
After considering this, can we say that insurance companies are frauds? Well no. Neither the insurance company is at fault and nor Mr. Ram. The problem aroused because Ram did not know about what company mean by pre-existing diseases.
What are pre-existing diseases?
Well, pre-existing diseases doesn’t mean only the illness that a person has at the time of buying a policy. It also includes:
- Medical history of illness. History of diabetes, heart attack, etc.
- History of any prior hospitalization.
- Signs of increase in blood sugar level or obesity.
- Symptoms such as excessive sweating, loosing breath.
- Ongoing medication for any disease.
- Skin disorders.
- Major injuries.
- Illness which one have had before taking the policy but might revert like hypertension, diabetes.
Whether or not, the hospitalization occurs because of the pre-existing injury, insurance company has the right to repudiate the claim if the pre-existing conditions were not disclosed. These pre-existing diseases have a deep impact on the entire policy framework.
Recommended Read : Possible reasons for a Health Claim Rejection
Terms and condition for pre-existing health condition:
- Premium loading might be applied to account for the greater risk.
- Waiting period is introduced and the cover of pre-existing ailment might be introduced after that.
- Both premium loading ad waiting period are implemented.
- Company might accept the proposal after a medical check-up.
- Exclusion of pre-existing conditions is sometimes deemed.
- If the conditions are really chronic and risky, a complete denial of proposal takes place.
Pre-existing conditions must not be confused with the disabilities from the birth. These don’t affect the insurance terms except from that they are not covered at all.
It is still advised to buy insurance policy with exclusions and waiting periods than committing a moral hazard and get claim denied. However, a proactive proposer might opt to get a voluntary medical check-up against the most common pre-existing diseases. This not only helps you to be clear about your health conditions but also saves the denial or loading on the basis of doubt.
Various common pre-existing conditions:
- Acid Reflux (Gerd)
- Alcohol Abuse And Recovery
- Anaemia
- Anxiety
- Arthritis
- Asthma
- Atrial Fibrillation
- Bipolr Disorder
- Blood Clot
- Blood Pressure
- Breast Cancer
- Blood Pressure
- Bronchitis
- Cancer
- Cardiovascular Diseases
- Cerebral Abnormalities
- Cholesterol
- Colon Cancer
- Polyps
- Congestive Heart Failure
- Coronary Bypass
- Depression
- Diabetes
- Digestive Track Disorder
- Drug Abuse
- Enlarged Prostrate
- Epilepsy
- Gastric Ulcer
- Glaucoma
- Heart Attack
- Heart Burn
- Hepatitis
- Insomnia
- Migraines
- Nasal Polyps
- Obsessive Compulsive Disorders
- Overweight
- Pacemaker
- Polycystic Kidney Disorder
- Seizures
- Stroke
- Thyroid
Recommended Read :
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- How to Select a Health Insurance Plan?
- Individual vs Family Floater Health Insurance
- Selecting Your Health Insurance Provider
- What Exactly is Lifetime Renewal of Health Insurance?
- Cashless Hospitalisation - Not Always Cashless
- How to Change Health Insurance Provider?
- Portable Health Insurance - Avoid Claim Rejections
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- What is Cashless Hospitalization?
- Types of Health Insurance
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- What is Day Care Hospitalization Health Insurance?
- Pre and Post Hospitalization Health Insurance
- Quick Health Insurance Policy - Beware
- What is Network Hospital for Health Insurance?
- What is Planned Hospitalisation?
- Emergency Hospitalisation
- Critical Illness Policy
- Preventive Health Care Plan
- Group Health Insurance Plan
- Indemnity Based Health Plans
- What is An OPD Cover Health Insurance?
- Myths On Health Insurance
The article is Wow! Thanks Shubham. This information is very very crucial before we sign up for any insurance policy. What exactly do you mean by the term waiting period? Is this the minimum duration after which the claims will be accepted? What exactly is the logic for this waiting period? Premium loading is I assume the higher amount of premiums required to be paid for people with pre-existing conditions to account for the company;s business functioning.
Well, thanks Rijal for liking this. The way you understood the term waiting period is correct.
If a person takes a policy and files a claim for the disease that he listed in the pre existing disease, he might have become prone to the same disease again or his disease is recurring. Just to rule out the second possibility, the waiting period is introduced. If the claim filed with respect to the listed illness is within the waiting period, it is considered to be recurring and is considered as not insured. The waiting period depends from illness to illness and is decided by the medical team of insurance company on the basis of the time a disease can reoccur.
Yes, Premium loading is done to handle the increase of risk that company takes by insuring such disease.
Makes sense. Thank you!
Health insurance companies often ask for this information, so they can refuse your claim for treatment of existing medical conditions. It’s important to get a pre-existing condition health insurance plan in these situations. It’s also important to know how and when to claim on treatment for these conditions. It’s not nice having insurance claims rejected when you need them so much.
With health insurance policy being essential for all, this article surely provides important information. The list of the various disease provided is surely an eye opener. But as the saying goes it is better to be safe than sorry. So a medical checkup before getting an insurance is the best option than being sorry.