Policy declined because of PED

21 Sep, 2021 | by Viswanath S

Hi Team,

My cousin applied for a Health insurance policy for his family. His wife has a health condition (rheumatoid arthritis) and hence insurance policy was declined for her from Max Bupa. we are exploring individual policy for her with other companies. Currently checking with Care insurance. I am looking for advise from the team on two aspects:

what are the options we have to challenge MaxBupa team decision as my cousins wife is still young early 30's.
is it advisable to go for an individual policy for her our go with floater policy with other insurers who are ok to provide a health insurance policy.

Also do you suggest any other insurance companies to explore for her health insurance.

Appreciate your help.

Thanks,

Viswanath

Purchase

2 Answer

Post

22 Sep, 2021

Enquiries_K&R

Dear Viswanath,

Every insurer have a right to assess the application and then make an offer for terms of acceptance of insurance risk. The assessment approach may vary depending upon factors like product features, insurer's internal guidelines about acceptance or rejection of certain applications, etc.

You may not find much merit in pushing and pursuing where the insurer has taken a decision of declining the applicant owing to pre-existing condition.

As an alternative, you may want to explore health insurance products offered by other insurers wherein pre-existing condition of rheumatoid arthritis is being covered. In some cases, insurers may also be willing to cover such applicants with certain exclusions. You will have to explore these aspects.

Hope it helps.

Regards

Krishnan

3 Comments

22 Sep, 2021

Viswanath S

Thanks Krishnan for your response.

Could you please suggest for any health insurance products offered by different insurance if you have come across any earlier. I am not able find this information upfront in any the policy wording documents.

Thanks,

Viswanath

22 Sep, 2021

Enquiries_K&R

Well Viswanath, this is quite a tricky question. The point is none of publicly available information about any product will have details of the underwriting assessment followed by the respective insurer. Hence, it would not be possible to point at any product or insurer.

You need a good advisor who can understand your peculiar challenge and facilitate in getting the required cover.

What I have seen is that in majority of such cases, it is hit and trial approach that works. You may want to explore products offered by Care Health. I have heard that they are open to assessment of such applications.

Hope it helps.

Regards

Krishnan

23 Sep, 2021

Viswanath S

Thanks Krishnan. Could you please advise.

Is it advisable to go for an individual policy for her or go with floater policy for the entire family.

Thanks,

Viswanath

27 Sep, 2021

Aayush Dubey

Hey Viswanath,

Hope you are doing well! I would suggest you get in touch with these insurers. As per my knowledge, they cover 'Rheumatoid Arthritis' after a certain waiting period as specified below:

Aditya Birla Health (Activ Assure) - Waiting Period of 24 Months
Aditya Birla Health (Activ Health) - Waiting Period of 24 Months
Care Insurance (Care Advantage) - Waiting Period of 24 Months
Future Generali (Health Total) - Waiting Period of 48 Months

These insurance companies should be able to insure her. As far as individual vs floater policy is concerned, it is always advisable that the person having a PED should go for an Individual policy and the remaining family members can get a floater policy.

Hope this helps!

Thanks!

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