You have probably seen the term ‘PED’ in your health insurance documents, but do you know what it actually implies and why it is so important? It is the primary reason why insurers ask in-depth questions about your medical history. This blog explains what PED in health insurance is, its waiting period, and how it affects health insurance policies.
Understanding Pre-Existing Diseases in Health Insurance
A pre-existing disease (PED) is a medical condition the policyholder had before acquiring health insurance coverage. As per the Insurance Regulatory and Development Authority of India (IRDAI), pre-existing sickness is a disease or medical condition for which the insured was diagnosed at least 48 months before purchasing the policy.
Some common examples of PED are high blood pressure, diabetes, asthma, thyroid, and so on. Some health insurance plans include exclusions or higher rates for pre-existing conditions since they usually result in higher healthcare expenditures. To prevent future claim rejections or issues, it is crucial to report all PED while acquiring health insurance.
Waiting Period for PED in Health Insurance
Almost all Indian insurers cover PED in health insurance after a waiting period. This may usually take 12 months to 24 months to 36 months, depending on the insurer. The insurer will reject any claim made for the treatment of a PED during this time.
Additionally, certain health insurers offer a reduction in the PED waiting period. By paying an additional premium with this rider, you can shorten the waiting period for your PED. Moreover, PED coverage is currently available from Day 1 in several healthcare packages.
Why Do Health Insurance Companies Restrict Coverage on Pre-Existing Diseases?
Since people with pre-existing conditions are more likely to experience health issues in the future, insurance companies avoid offering insurance coverage to them. Since these people would need medical care on a regular basis, the insurance may have to bear the expenses.
In addition, PED in health insurance coverage is avoided by providers also due to the associated financial risk. This strategy ensures the overall sustainability of the insurance pool.
List of Pre-Existing Diseases in Health Insurance
If you cannot disclose PED in health insurance coverage, you might face serious repercussions for this. Insurers have the right to reject the claim or cancel the policy. Here are the diseases approved by the IRDAI, insurers can consider as pre-existing ones:
- High blood pressure
- Asthma
- Thyroid
- Diabetes
- Arthritis
- Chronic Obstructive Pulmonary Disease (COPD)
- Kidney disease
How PED Affects Health Insurance Policies?
When applying for health insurance, it is crucial to disclose all of your PED in medical insurance since they can affect your policies. Here are the following ways in which PED affects your policies:
- Claim rejections: The insurance provider may reject a claim and refuse further financial coverage if you fail to reveal pre-existing conditions while purchasing the policy.
- Initiate waiting period: If you reveal pre-existing conditions, the waiting period starts on the first day, and coverage starts as soon as the waiting period ends.
- Accurate premium: Premium loading for pre-existing diseases is done based on the risk involved and aids in setting proper rates if you disclose pre-existing disorders while enrolling for a health insurance plan.
- Relief from future disputes: PED coverage is subject to a waiting period. Failing to disclose your PED to a provider when applying for a health plan may lead to future problems.
- Portability advantages: When you transfer your pre-existing health insurance to a different insurance provider, you can keep the accrued waiting period by disclosing your PED.
Tips for Buying a Health Insurance Plan If You Have Pre-Existing Medical Conditions
. Disclose Your PED
Avoid hiding any pre-existing medical condition from your insurance provider when you purchase the policy. This is crucial since the insurer may deny your health insurance claim if your pre-existing disease is revealed during treatment.
. Be Transparent About Premium Charges
It is crucial to remember that individuals with pre-existing conditions pay higher rates to insurers. Depending on an applicant’s age, condition, and other factors, the insurance provider will calculate the accurate premium amount. Regardless of the premium costs, you must be open about their medical history.
. Make Use of the Time Period
Having a PED might make it difficult to obtain health insurance coverage. However, to identify a PED, health insurance companies can only take into account the medical records of the previous 48 months. Thus, 48 months after the diagnosis or treatment of your pre-existing condition, you can get PED in health insurance coverage
. Choose a Plan With a Lower Period
You should choose a health insurance policy with a shorter PED waiting time, whether you purchase a family or individual health plan.
Conclusion
Understanding PED in health insurance is important since it is essential to enrol with this plan if you are at risk owing to lifestyle choices or have a family history of diseases. When dealing with high medical costs, being open and honest about your medical history and pre-existing problems guarantees a more seamless claim procedure. Please take look at Diabetes Health Insurance which one of the policy that cover PED and also you can take look at is a simple process that helps you avail of healthcare benefits ABHA Card : Apply Abha card online.