The concept of Pre-existing disease coverage in Health Insurance Explained

Updated: Apr 24, 2019

Finding the right health insurance policy for you can be a hassle. You have to read the fine print, crosscheck every possible detail, see if it matches your requirements and budget, and then make the purchase. In addition to all this the terms and conditions, waiting period, exclusions, etc. increase the difficulty of arriving at a decision. One such troublesome aspect of health insurance is the concept of pre-existing diseases.

What is a pre-existing disease?

A pre-existing disease is any health condition that the individual suffers from before seeking health insurance. It can include acne, cancer, diabetes, high blood pressure, etc. Pre-existing disease health insurance is definitely an issue, but it is not an impossibility. There are companies that offer pre-existing disease coverage at a higher premium.

Why don’t insurers prefer such conditions?

Insurance companies are wary of people with pre-existing diseases because they pose a possible risk to the companies. Someone who has a pre-existing condition is highly likely to need medical attention and treatment, thus requiring the insurer to provide financial support. Healthy persons with no such disease may or may not fall sick, so they are not considered a likely liability.

Is it possible to circumvent this problem?

As mentioned before, the situation is not impossible. In fact, with the emergence of more and more insurance companies, the tough competition is making several insurers rethink their policy regarding pre-existing disease health insurance. Some are beginning to include these diseases in their health insurance coverage and to tweak the conditions a little. Many companies do provide pre-existing disease health insurance with an exclusion or waiting period.

What can you do to protect yourself from falling into this conundrum? Here are some things to keep in mind:

1. Be fully aware of what the term signifies

Short-term problems – no matter how frequent they are – do not count as pre-existing diseases. Colds coughs and fevers do not affect your chances of being granted a health insurance policy. Insurers will only watch out for ailments that have long-term, significant side-effects.

2. Get checked

Nevertheless, you still can’t be entirely sure if you don’t fall in this category until you get a professional medical opinion. Some insurance companies grant health insurance without asking you to get properly checked, and then when the time comes to settle the claim, deny your request because of pre-existing symptoms. To avoid this, go for a check-up and show your insurance company proper proof.

3. Go through the policy details

The extent to which pre-existing diseases are excluded depends on the insurance company. For instance, while some companies consider the person’s entire medical history while checking for pre-existing conditions, some only go as far back as four years. So, before you purchase or reject a plan, make sure you are clear about what counts as a pre-existing disease health insurance for that company and what their policy regarding it is.

4. Dealing with the waiting period

Most insurance plans come with a waiting period of around two to four years. Ensure that you complete one policy’s waiting period before you shift to another – otherwise the incomplete waiting period is not counted.

As you can see, pre-existing diseases are not exactly a roadblock. Though you may have to pay higher premiums to be protected against them, it can still be beneficial in the long run. All said and done, the purpose of any health insurance plan is to provide financial security during a health crisis, and pre-existing diseases don’t entirely interfere with this. To find an insurance policy suitable for you, go ahead and visit ManipalCigna’s website .


ManipalCigna Health Insurance Company Ltd (Formerly known as CignaTTK Health Insurance Company Limited) | CIN U66000MH2012PLC227948 | IRDAI Reg. No. 151 
Reg. Office: 401/402, 4th Floor, Raheja Titanium, off. Western Express Highway, Goregaon (East), Mumbai- 400 063 | Toll free number – 1800-102-4462 | Website address –
Trade Name / Trade Logo belongs to MEMG International India Private Limited and Cigna Intellectual Property Inc. and is being used by ManipalCigna Health Insurance Company Limited under license. For more details on risk factors, terms and conditions, please read the sales brochure/ sales document available on our website (Download section) before concluding a sale.

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