Should we declare our PEDs or keep quiet till the waiting period is over?

According to IRDAI, a pre-existing disease (PED) refers to any ailment, illness, health condition or disease that has been experienced, diagnosed or treated up to 48 months before buying the health insurance policy.  Insurance companies do extend Health Insurance cover to people with PED; albeit at a higher premium and with pre-policy medical screening and tests to be undergone. Moreover, acceptance of application for health insurance is decided based on the extent and severity of the condition, given the high risk of insuring such profiles. It is important to be transparent about medical information when purchasing a policy so there are no issues in the future that could lead to claims rejection or denial.

All Health Insurance plans specify a Waiting Period for Pre-existing Diseases. The expenses for treatment of PED can be claimed only once the waiting period is completed. On average, the waiting period for pre-existing diseases is two to four years. This time period depends on your health insurer and the type of health insurance plan chosen.

What happens if you don't declare PED at the time of application, or during the policy year?

  • Medical Claims could be rejected or denied due to Non-Disclosure of PED. Banerjee purchased a health insurance policy with a Sum Insured of Rs. 5 lakhs. She had been diagnosed as having borderline high hypertension, but she did not disclose this to the insurer prior to purchasing the policy, as she was afraid of being made to pay a higher premium. Towards the end of the first year of the policy, Mrs. Banerjee was admitted to the hospital with fluctuating blood pressure and palpitations. At the time of claiming hospitalization expenses, her health insurance company denied her claim as they found out about her pre-existing condition and declared it as a case of non-disclosure.
  • Already served Waiting Periods are nullified. Usually, health insurance companies would cover pre-existing diseases after the waiting period is served. However, if the insurer gets to know mid-way through the policy that the insured member withheld information regarding their PED, then the waiting period already served becomes invalid.
  • Other insured members suffer. For Family Floater Health Insurance plans, other family members’ coverage is also impacted when the claim gets denied or the policy gets revoked.
  • Cumulative premium paid goes to waste. Additionally, the premium paid so far becomes pointless as the insurer could cancel the policy for not divulging information truthfully.
  • Future applications could get impacted. When applying for future insurance plans, your application will be affected and inspected to check for accuracy.

Let’s suppose one manages to get a health insurance policy by not disclosing pre-existing disease initially. During the course of the policy year, you may need to undergo treatment for some other condition. At that time, your PED could get detected in the medical reports related to the other treatment, which when submitted for claims settlement would lead to rejection or denial of payment.

Therefore, you should always declare your medical history and health conditions prior to purchasing the policy or during the course of the policy, whenever diagnosed.

There are numerous plans available in India that offer health insurance cover to applicants with PED at lower waiting periods for slightly higher premiums. Even if you have to pay more and wait for a few years, you will get coverage when you need it most and you will remain covered thereafter. Moreover, your health insurance plan will take care of hospitalization expenses related to accidents, emergencies and other health expenses incurred, as per the terms and conditions of the specific policy. These terms and details are mentioned in the Customer Information Sheet or Policy Wordings which should be read thoroughly prior to purchasing a plan.

We invite you to visit for more information on different health insurance policies in India that cover pre-existing diseases after respective waiting periods and other associated conditions. SANA.Insure is a health insurance portal that provides detailed comparisons on various health insurance plans tailored to your requirements. Health Insurance is Made Easy at SANA.Insure!

If you have an existing policy, you can assess the specifics of your plan with the help of SANACheck – a health check for your health insurance policy. Get your health policy checked and enter some basic details about your plan to learn more – download information on over 45 features of your policy, including waiting periods.

Should you need any assistance along the way, you can connect with SANA.Insure’s Health Insurance Experts. They will guide you through the process and help you understand the complex terms and conditions attached to your health insurance plan. You get in touch with us over WhatsApp on 8278271818 or call us on 1800 202 8118.

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