What is the pre-existing disease clause in a health insurance policy, and what are its implications?

Pre-existing disease clause in health insurance policies

Health insurance policies

You need health insurance to manage your expenses if your health deteriorates. But what if you pay your insurance premiums on time, and still your claim is rejected? The reasons for claim rejection are missing documents, non-disclosure of pre-existing disease, etc. The non-disclosure of the pre-existing disease is the most common reason for claim rejection. 

But if you declare a pre-existing condition, your claim will not be rejected. So, therefore, it makes sense to declare your pre-existing diseases to make sure that your claim is not rejected on these grounds. Also, it is mandatory for all health insurers to cover pre-existing diseases after 4 years. Some health insurers cover pre-existing diseases after 2 years as well. You need to talk to your insurer and read the documents carefully to understand the implications. You should remember that hypertension and obesity are also considered pre-existing diseases. 

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What to do if your claim is rejected but you were not suffering from any pre-existing condition at the time of purchase?

The definition of pre-existing disease has been defined by the insurance regulator and now the definition is standardized. Therefore, there should not be any discrepancy in the applicability. For example, if you were not suffering from hypertension at the time of purchase of the policy, then your claim cannot be rejected on the basis of detection of hypertension at a later stage. If you have any issues, then you can get your concerns sorted out by the insurance ombudsman. Your claim redressal concern will be taken up by the insurance ombudsman.

You should read the documents carefully and make full disclosures of all pre-existing conditions. Also, you need to disclose family history, accidents, injuries, chronic problems, etc. If you make use of a digitally enabled insurer and you disclose all your medical history, you should not face any claim rejections.

The most common reason for the rejection of medical claims is the existence of pre-existing diseases. By declaring it, you put the onus on the insurer to complete your claims. Therefore, you should not hide your medical history. Paying some extra premium is better than getting your claim rejected at a later date when you actually need the money.

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Pre-Existing Diseases In Health Insurance Explained


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