Pre-Existing Disease

Pre-existing disease clause in the health or medical insurance policy is defined as a medical condition which is present in a person before the inception of the medical insurance policy. Usually, when buying health insurance, the insurance companies ask to get a medical test done of the applicant to evaluate the risk of issuing the policy. One of the major factors that decide premium in the policy is the medical condition of a person. If a person is detected with diabetes then it will be classed under pre-existing disease and any complication that arises requiring medical treatment due to diabetes won’t be covered under the policy up to certain period called waiting period in medical insurance. Treatment for the pre-existing disease is excluded from the standard policy for 3 to 4 years of waiting period depending upon the insurer. Also, the policyholder has to ensure that there is no gap in the policy term to ensure the continuous count of the pre-existing waiting period. Any break in the health insurance cover the waiting period will be reset again from the start. In recent times, the IRDAI (Insurance Regulatory and Development Authority of India) has allowed health insurance portability. This means if you are not happy with your current medical insurer then you can port your policy without breakage of the term to another insurer without losing the count on the waiting period. Hence you don’t have to go through the waiting period count all over again. If you have completed 2 years with one insurer and then port your policy to another insurer then you will get coverage for your pre-existing ailments after 2 years and not 4 years as you have already completed your quota of 2 years with the previous insurer.


Pre-existing disease clause under group medical insurance policy

A Group medical Insurance or group health Insurance policy covers a group of people working under the same organization.
Group medical insurance is often taken by an employer for its employees as a perk of working for the organization.
A single policy is issued to the employer stating the terms and conditions.
The employees enrolled in the group medical insurance policy usually get an id card which mentions required details of the person enrolled in the group policy.
This card can also be used to get cashless claims at network hospitals empaneled with the particular health insurance company.

One of the benefits of group medical insurance policy that there is no pre-existing disease waiting period and all the ailments of the people enrolled in the group get coverage from day one. Also, no medical test is required to enroll in the group medical insurance policy. This is because a lot of people get enrolled in the group insurance policy and the premium paid under the policy is high compare to the standard policy. Although the coverage and choice of cover under group medical insurance are standard and it does not provide the flexibility of coverage as per individual needs of the people in the group.

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