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

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