This condition decides to payability in the majority of the claims. All you need to know about Pre-existing diseases in Health Insurance.
Pre-existing diseases are the medical conditions that the policyholder is already suffering from the diseases before purchasing a health insurance policy.
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As per the definition of IRDAI any condition, ailment, injury, or disease which is diagnosed by a physician within 48 months prior to the effective date of the policy issued by the insurer or its reinstatement or b) 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.
Generally, this waiting period condition varies from 12 months 48 months continuous policy coverage depends on the product of the Insurers. On completion of the waiting period, the insurance company will start covering pre-existing illnesses.
In case the policyholder enhanced the sum insured in the mid of the waiting period, the exclusion and a waiting period will apply afresh to the extent of the sum insured increase.
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 shorter waiting period policies to cover the 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 the insurance broker to recommend the right policy.
Please feel free to reach us at sarath.reddy@ethika.co.in if you need more information.
Susheel Agarwal
Susheel is a certified Happiness Coach, which enables him to help organizations develop healthy and happy workplaces. Years of extensive in-depth research by interacting with various leaders of happy & not so happy organizations, attending several Happiness and Leadership programs along with his own authentic experiences, Susheel has been successful in establishing a happy workplace. He currently works as a Thought Leader and a Passionate Coach, educating corporate leaders to do the same.
