Have you Noticed this Condition in your Health Insurance Policy?


image of doctor - Pre-existing diseases in health insurance

All you need to know about pre-existing diseases in Health Insurance.

Pre-existing diseases are diseases that the policyholder already suffers from before purchasing a personal health insurance policy. This policy condition determines playability in a majority of health insurance claims.

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As per the IRDAI definition, any condition, ailment, injury, or disease that is diagnosed by a physician within 48 months prior to the effective date of the policy issued by the insurer or its reinstatement or for which medical advice or treatment was recommended by, or received from, a physician within 48 months prior to the effective date of the policy issued by the insurer is a pre-existing disease and will not be covered by the insurer for a specified period.

Generally, this waiting period condition varies from 12 months, to 48 months of continuous policy coverage, depending on the product of the insurer. On completion of the waiting period, the insurance company will start covering pre-existing illnesses.

In case the policyholder increases the sum insured in the middle of the waiting period, the exclusion and a waiting period will apply again to the increased sum insured.

insurance broker illustrator | Meme explaining

Disclosing pre-existing diseases

Health insurance policies are given with “utmost good faith.” In absence of this, the Insurers will have a right to reject the claim / cancel the policy on the basis of misrepresentation of facts.

Ethika recommendations

Always, opt for policies with shorter waiting periods to cover pre-existing diseases.

It is always crucial to go through a bunch of conditions in all the medical insurance policies that are available in the market.

Hence, it is suggested to take the help of an insurance broker to recommend the right policy.

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Susheel Agarwal

Susheel is the CEO of Ethika Insurance Broking P Ltd. This company, which has a current value of 10 million dollars, was bootstrapped by him and two of his friends. He attributes his success to his ability to inspire others to seek happiness at work.