How Do Health In­sur­ance Com­pa­nies Han­dle the Pre-Ex­ist­ing Dis­eases Clause

Consumer Voice - - Bfsi -

Refuse to ex­tend in­sur­ance cover: If you are a se­nior cit­i­zen (say 70+) and are suf­fer­ing from a chronic dis­ease (say di­a­betes), and want to take out a health pol­icy, chances are that health in­sur­ance com­pa­nies will refuse to cover you on the grounds that this is a pre-ex­ist­ing dis­ease (PED) that is likely to bring in com­pli­ca­tions like dial­y­sis or kid­ney trans­plant. Med­i­cal tests: Med­i­cal tests are lab­o­ra­tory tests that are manda­tory (as per IRDA guide­lines) from the age of 45 years, for health in­sur­ance com­pa­nies to as­cer­tain the state of health of the per­son to be in­sured (es­pe­cially with re­gard to PED). Based on the re­sults, the in­sur­ance com­pany takes a de­ci­sion to cover or not cover a per­son un­der a health pol­icy.

Wait­ing Pe­ri­ods for Pre-Ex­ist­ing Dis­eases Pre-ex­ist­ing dis­eases are those which the in­sured suf­fers be­fore or at the time of tak­ing the pol­icy and are sub­ject to terms and con­di­tions of the in­surer. Many com­pa­nies do have spe­cific wait­ing pe­ri­ods (rang­ing from one year to four years) af­ter which pre-ex­ist­ing dis­eases get cov­ered, pro­vided the pol­icy re­newals have been con­tin­u­ous and with­out any break. Make sure you dis­close what you al­ready know. Non-dis­clo­sure of a pre-ex­ist­ing dis­ease and du­ra­tion of af­flic­tion is the sin­gle big­gest rea­son be­hind claim re­jec­tions in med­i­cal in­sur­ance claims. This is also the sin­gle big­gest prob­lem faced by con­sumers while fil­ing med­i­cal in­sur­ance claims. At the time of is­su­ing the pol­icy, health in­sur­ance com­pa­nies gen­er­ally ex­clude these pre-ex­ist­ing dis­eases/con­di­tions: high blood pres­sure, di­a­betes, heart dis­eases, AIDS, preg­nancy, cancer and cataract

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