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Do Health Insurance Plans Cover Rare Diseases

It is the need of the hour for every individual, and one should not neglect to purchase health insurance because of pre-existing illnesses. In fact, it is a predominant reason for buying health insurance in the first place. A few years ago, if you had any pre-existing medical condition, it was out of the question for you to buy health insurance because most of the insurance companies would not cover it in their policies. But today, it is comparatively easier to get medical insurance with pre-existing diseases or conditions.

What is a pre-existing illness?

In general terms, a pre-existing illness is any medical condition that the policyholder has at the time of buying medical insurance. This medical condition could include injuries, chronic diseases, or even pregnancy. IRDAI (Insurance Regulatory and Development Authority) has given a more specific guideline to identify any condition as pre-existing.

According to IRDAI, any condition would be considered pre-existing under the insurance policy if:

• It was diagnosed by a doctor within 48 months prior to the date of your policy’s commencement.

• Any medical treatment that was recommended or received within the period of 48 months prior to your policy’s commencement.

• In addition to this, any condition resulting in a serious disease within three months of the commencement of your policy is also classified as a pre-existing disease.

Is it difficult to get insurance for pre-existing illnesses?

Today, it is relatively easier to get any pre-existing illness covered by a health insurance policy. However, if you do not have any pre-existing illnesses, then you have an upper hand and you are easily eligible for any comprehensive health insurance policy.

There is a possibility that any individual with a pre-existing disease is more likely to file claims than someone without one. Hence, this makes the policyholder a higher financial risk for insurance companies. But now, due to the latest amendments and the fact that almost every individual is prone to many lifestyle diseases, it is possible to get a health insurance policy that covers pre-existing diseases.

Should you disclose your pre-existing medical conditions?

Earlier, people would refrain from telling their insurers about their medical history or about any pre-existing conditions because they were uncertain about being eligible for the policy. But now that insurers cover pre-existing diseases, it’s time to put an end to this stigma.

It is very important that you disclose your pre-existing illnesses at the time of buying your health insurance policy. If you don’t and if your insurer finds out about it after the policy is issued, then you may have to face legal or financial consequences for the same. Also, if you file a claim for an illness due to pre-existing condition, there are high chances that it would get rejected. On the other hand, disclosing your illnesses will help you get better insurance coverage.

Here are the top three things you should know before you buy pre-existing disease insurance.

Waiting period

Every insurance company has a waiting period before the policy commences. This waiting period is usually longer if you have pre-existing medical conditions. It is not possible to receive immediate treatment. The waiting period may range anywhere from 30 days to 4 years. This differs from one company to another. Until your waiting period is over, you will have to bear the treatment costs by yourself.

However, certain insurance companies also give you the option to either reduce or eliminate your waiting period. This can be done by paying an extra premium. If you are financially capable and in urgent need of a health insurance policy, you can find an insurance company that offers this feature.

Premium price

There is a chance that as a policyholder with pre-existing medical conditions, you will have a higher premium price compared to a policyholder who is perfectly healthy at the time of buying the policy. Your premium amount is affected by factors like your illness, age, policy coverage, etc.

Even though the premium prices may be higher for pre-existing disease insurance, you should inform the insurer about your medical history before buying your policy. It is not possible that you hide your pre-existing conditions at the time of purchasing the policy and then receive treatment for the same when the policy begins.

Terms and conditions

It is important that you meticulously read the terms and conditions of the health insurance company. There is a possibility that some insurers may not cover certain medical conditions. Hence, you must know all about their inclusions and exclusions in terms of diseases as well as services.

It could be a hassle to buy insurance that covers pre-existing diseases, but under no circumstances does that stand as a reason for why you should not purchase a health insurance policy. With just a little research, you can find a policy that provides all the necessary benefits within your budget.

Kotak General Insurance offers a diverse range of health insurance services and products to help you secure your future from any uncertain medical emergency.

Disclaimer: The content provided is for education and informational purpose only, none of the information contained in our blog amounts to any form of opinion or advice. Please go through policy related documents carefully or consult an expert before making any insurance-related decisions.


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