All About Pre Existing Diseases and Conditions in Health Insurance Policy


21 Jul 2023

How Health Insurance Policy Covers Pre Existing Diseases and Conditions

Health insurance plans bring a lot of benefits to the table. For starters, they offer financial assistance for emergency medical needs. They ensure that you are never short of funds when it comes to medical attention. And most importantly, they offer complete peace of mind for the insured.

If you are planning to buy a health insurance plan, the chances are high that you will come across the term pre-existing diseases. What exactly is a pre-existing disease, and how does it impact your health plan?

Definition of Pre-Existing Disease

There has been a change in the definition of pre-existing diseases recently. Earlier, it used to mean any chronic disease that the insured had while buying the policy or developed within 3 months of buying the policy. Common examples include cancer, high blood pressure, diabetes, etc.

If you were to claim the insurance due to any of these pre-existing diseases, you would not receive any benefits from the health insurance plan.

However, the IRDAI updated the definition of pre-existing diseases in February 2020. According to IRDAI, any sickness, medical condition, or disease that the insured was diagnosed with prior to the purchase of the plan is a pre-existing disease. Also, if the insured has been receiving treatment for any medical condition 48 months prior to buying the policy, it is also a pre-existing disease. This updated definition has resulted in the rejection rate of claims have dropped by a considerable margin.

Things To Remember

Here are some things to keep in mind as far as pre-existing conditions are concerned.

1. Terms and Conditions:

Even though the IRDAI is doing its bit to make health insurance plans more accessible, it is important that you check the terms and conditions of the plan before purchasing it.

2. Pre-existing Coverage:

Not all health plans will offer coverage for pre-existing diseases. Thus, you must check with your insurance provider about these conditions before buying the policy.

3. Waiting Period:

The waiting period is the duration during which you cannot claim your health insurance policy. The duration can range between 30 days to 4 years. If you undergo any medical procedures during this window, you must pay for them from your pockets. However, once you complete the waiting period, you can even claim the policy for pre-existing disease.

4. Waive Off Waiting Period:

You can choose to waive the waiting period by paying a small premium. This clause will either remove the waiting period or reduce it by a considerable margin. You must ensure that you discuss with your insurance provider regarding this prior to the purchase of the policy.

5. Disclose Pre-existing Diseases:

Not disclosing pre-existing diseases or conditions can have a negative impact during policy claims. Thus, it is always a good idea to inform your health insurance provider about any pre-existing diseases.


There are several factors that you must consider before buying a health insurance plan, and pre-existing diseases are one of them. Ensure that you disclose any such condition to your insurance provider, and do not hesitate to explore ways to reduce the waiting period for the medical condition.

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Team Kotak GIC

The content of this blog has been created and carefully reviewed by the esteemed team at Kotak General Insurance, with the sole purpose of providing valuable guidance and sharing insights on the importance of general insurance. Our objective is to assist users in making informed decisions when purchasing or renewing insurance policies for their cars, bikes, and health. Our expertly curated information aims to empower our readers with the knowledge they need to protect their valuable assets and financial interests.