How much coverage can I get? Will certain conditions be covered? How about the premium and waiting period?
These might be the questions coming from individuals who are suffering from any pre-existing medical conditions when applying for medical insurance.
The term ‘pre-existing conditions’ is surely causing us major stress. It goes back to a thorough medical history of any condition (past surgeries, medications, hospitalization, major accidental injuries, or illnesses). But do you understand what pre-existing medical conditions mean? How do you define and ensure if you have one? Find out more throughout this article.
What is a pre-existing condition?
A pre-existing condition is a physical or mental condition that has been diagnosed or treated within the policy’s look-back period. The insurance provider will determine an applicant’s condition to decide the amount of coverage and premium that the insured can get.
Typically, the ‘look-back’ period (for your insurer to investigate your medical record) is around 60 to 180 days prior to the effective date but it can be 12 to 36 months prior to the effective date. However, the terms and conditions pertaining to coverage of pre-existing medical conditions differ from policy to policy.
Conditions like diabetes, cancer, asthma, and heart disease are examples of pre-existing conditions. The majority of these conditions are generally considered to be long-term or chronic. Different insurance companies have their own preference for ‘pre-existing conditions’ so you would have to read the literature carefully.
How does your insurer check out if you suffer from any pre-existing conditions?
- You’ll be asked questions regarding your health.
- You will be required to give permission for your insurer to access any medical records needed to validate your information.
- You also may have to undergo a medical exam as part of the underwriting process to indicate an underlying medical condition – whether you are aware of that condition or not.
Can I still get medical insurance if I have pre-existing conditions?
Insurers are wary of providing coverage to individuals with pre-existing conditions. This is because such people are more likely to require treatment and, as a result, pose a greater financial risk to insurers.
Most of the time options are available so that pre-existing conditions can be covered. Either an increase in the premium cost or by selecting a plan which can ignore all (or almost all) pre-existing conditions entirely.
Policyholders have a duty to provide all information and documentation required to the insurers when applying for insurance. There are three ways how pre-existing conditions will affect your policy and premiums after you honestly disclose the details.
Here is what you need to know about medical insurance policies for pre-existing diseases.
A waiting period is a span of time in which you cannot claim the policy benefits from the insurer upon the insurance agreement. This means the insurance company will not cover any hospitalisation or medical expenses related to your pre-existing disease that is incurred during the waiting period. The duration will vary among insurance companies.
Premium Loading is applied when an insurance company is dealing with a high-risk candidate. This includes medical history, dangerous jobs, and risky pastimes. The insurance company will include the pre-existing condition but for a higher premium.
The amount is added to the premium to provide cover for the individual that is already affected by the pre-existing disease.
Waiting Period + Premium Loading
The insurance company may have decided to load the premium as well as apply the waiting period for some critical cases.
Never Hide a Pre-Existing Condition
It is essential to disclose your pre-existing conditions honestly. Lying on your application form will only lead you to trouble. You may be considered breaching the principle if you hide your pre-existing conditions. If the company found out that you lied about your condition, they may penalize you by denying your application.
Though coverage would not be available in the initial few years of the waiting period, you would ultimately enjoy coverage for your pre-existing conditions when the waiting period is over.
Medical insurance for pre-existing conditions
Having a pre-existing condition should not deter you and your family from securing your financial future.
It is better to consult an expert if you have questions about your health. You may even be surprised to learn that your specific condition is not much of a barrier at all. The earlier you sign up for your medical insurance, the better chances you will get at securing a lower premium.
If you have any questions pertaining to medical insurance, life insurance or critical insurance, reach out to our insurance experts at Bjak to assist you! We can help you to get the best insurance that suits your needs within your budget too!
Learn more about other exclusions in medical insurance here.
(Sources: LIAM, HDFCERGO)