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Health insurance proposal with an undiagnosed PED which is part of permanently excluded disease

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17 Aug, 2021 by  Avinash Sonee

Hi,


One of my customers has an intermittent abdomen pain since 3 years and he wants to take a policy now. Star Health has rejected the proposal. I'm guessing that other private companies may do the same.


So, I was looking to apply for National Insurance's National Mediclaim policy (UIN: NICHLIP21558V062021). The policy wordings has a clause citing List of illnesses permanently excluded if existing at the time of taking the Policy.

which includes


Inflammatory Bowel  Diseases 

K 50.0 to K 50.9 (including Crohn's and Ulcerative colitis)  

K50.0 - Crohn's disease of small intestine; K50.1 -Crohn's disease of large intestine; K50.8 - Other Crohn's disease; K50.9 - Crohn's disease, unspecified.

K51.0 - Ulcerative (chronic) enterocolitis; K51.8 -Other ulcerative colitis; K51.9 - Ulcerative 

colitis,unspecified.


Now the PED for this customer is still not diagnosed to be any of the above mentioned list. The doctors are yet to ascertain the exact diagnosis.


If the PED is mentioned along with the supporting reports and consultation papers and the policy is issued with a PED waiting period of 4 years and then after policy issuance, if the PED is diagnosed to be one of the above permanently excluded diseases, will it still be permanently excluded or will it come under a PED with 4 years waiting period?

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1 Answer

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17 Aug, 2021

If the existing medical condition isn't classified as any of the permanently excluded PEDs, it should get covered after a waiting period of 4 yrs.


The best way of addressing this is to make full disclosure in the proposal form, take the required medical tests demanded by the Insurer and let their underwriting team decide about the nature of illness.


Have you spoken to National Insurance about your client's proposal?


Best,

Asad

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17 Aug, 2021
Avinash Sonee
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22 Aug, 2021
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