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What is Pre-Existing Diseases & its Clause | Everything You Need to Know About Pre-Existing Diseases

What is Pre-Existing Diseases & its Clause | Everything You Need to Know About Pre-Existing Diseases

Published on 29 December 2022 .Views 55 .Comments 0
In this article, we will be discussing Pre-Existing Diseases- What is it, what are its clauses, and what are tips one should follow regarding Pre-Existing Diseases while selecting insurance plans. So, let’s get started!

What are Pre-Existing Diseases?

  • A Pre-Existing Disease (PED) refers to a medical condition that a person is already suffering from (at least for the last 4 years), before the policy purchase.
  • Unfortunately, the PED waiting period is an obstacle for people who want to claim their PED expenses.
  • The good news is that some plans cover pre-existing diseases from day one.

Pre-Existing Disease Clause:

  • When an individual buys an insurance policy, there is a waiting period for PED of around 24 months to 48 months varying as per insurance policies.
  • If an individual does not discloses his/her PED, it comes under the case of fraud, and there could be some complications.
  • If a company thinks about a disease that can cause a lot of expense in the future, then that PED can permanently be excluded by the insurance company.
  • Other than this, insurance companies can also impose restrictions for payment up to a certain limit, even after the completion of the waiting period.

Things to Remember:

  • When individuals opt for the portability of insurance policies, then the waiting period for PED is carried forward.
  • If the sum assured is increased say from Rs. 10 Lakh to Rs. 20 Lakh, then the waiting period for the increased assured amount will be calculated separately.
  • Even if a new member is added to the insurance policy in the family floater plan then the waiting period PED of the new member will have a different waiting period.
Some Diseases are not even PED, but if happen there is waiting periods for the same, they are:

1.    Any type of gastrointestinal ulcer
2.    Cataracts
3.    Any type of fistula
4.    Macular Degeneration
5.    Benign prostatic hypertrophy
6.    Hernia of all types
7.    All types of sinuses
8.    Fissure in ano
9.    Haemorrhoids, piles
10. Hydrocele
11. Dysfunctional uterine bleeding
12. Fibromyoma
13. Endometrosis
14. Hysterectomy
15. Uterine Prolapse
16. Stones in the urinary and biliary systems
17. Surgery on ears/tonsils/adenoids/paranasal sinuses
18. Surgery on all internal or external tumors/cysts/nodules/polyps of any kind including breast lumps with exception of Malignant tumors or growth
19. Pancreatitis
20. Diseases of gall bladder including cholecystitis
21. Gout and Rheumatism
22. All forms of Cirrhosis
23. Surgery for varicose veins and varicose ulcers
24. Tonsilitis
25. Alzheimer's disease
26. Chronic Kidney Disease
27. Surgery for vertebral column disorders (unless necessitated due to an accident)
28. Joint Replacement Surgery
29. Hypertrophied turbinate
30. Surgery to correct the deviated nasal septum
31. Treatment for correction of eyesight due to refractive errors recommended by an Ophthalmologist for medical reasons with a refractive error greater or equal to 7.5
32. Congenital internal diseases or anomalies
33. Parkinson’s Disease
34. Bariatric Surgery
35. Genetic Disorder
All the above mentioned are some of the diseases that will have a different waiting period of around 24 months aside from the waiting period for PED.

Tips for PED:

  • Never hide pre-existing diseases
  • Taking medical insurance after 48 months from PED
  • Opt for lower waiting period plans
  • Should look for Co-Payment Plans
  • In Corporate Plans, PED does not have waiting periods
  • Many Insurance Plans do not have any waiting periods for PED
What Should Individuals Do:

Pre-Existing Diseases (PED) are an important factor when selecting insurance policies. Individuals should carefully assess all the insurance policies and should also filter the plans based on the waiting period for PED. One should also not hide any PED from insurance companies to avoid any complications ahead.

Disclaimer: The information here is provided for reference purposes only and should not be misconstrued as investment advice. Under no circumstances does this information represent are commendation to buy or sell stocks or MF.

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