25 Mar, 2022 | Health Insurance

What Is The Difference Between A Pre-existing Disease And Medical History?

Aakansha Jain
By Aakansha Jain
Budding Content Developer at Beshak
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Your insurability & health insurance premiums are decided based on your medical history including pre-existing diseases. Hence, it is important that you provide every detail related to your medical history in the proposal form as accurately as possible. Based on the medical declarations you provide in the proposal form, the insurer(s) may also call for a pre-policy medical check. The final assessment of your medical history and pre-existing diseases will be done by the insurer on the basis of your declarations and pre-policy medical check. 

In this article, let’s learn about what is pre existing medical conditions, medical history, the difference between the two. Let's also understand how your medical history can have an impact on your health insurance and the things you should know when buying health insurance for pre existing diseases. 

First, let’s take a look at the meaning of a pre-existing disease and medical history.

What is pre existing disease in health insurance?

A pre-existing disease is any medical condition or illness for which you’ve had a positive diagnosis or have undertaken treatment within 48 months prior to applying for health insurance.

What is medical history?

Any disease which has afflicted you in the past is considered part of your medical history. If the concerned illness existed within 48 months of applying for health insurance, it’s called pre-existing disease. Otherwise, all other medical conditions are noted in your proposal form as medical history/other conditions. Every detail about an illness, disease, surgery, or any major injury that you’ve had in the past - even those that you had in childhood - comes under your medical history. 

Difference between a pre-existing disease and medical history

We looked at the definition of a pre-existing disease and medical history above. From the perspective of health insurance, the main difference between pre existing diseases and medical history is that - while your pre-existing diseases are excluded from policy coverage for a certain period (2/3/4 years depending on the policy), the chances that the insurer will exclude diseases that are part of your medical history from the policy scope are minimal.

For instance, Rohan, 30 years old, had cancer two years ago which was cured with the help of medication. If he is buying a health insurance policy, cancer will be considered a pre-existing disease. 

However, in case he had cancer in childhood which was cured before he became an adult, the insurer cannot consider cancer as a pre-existing disease & apply the pre-existing disease waiting period on cancer. However, it will be noted in the policy document as part of medical history.

How does the insurer use each of the above?

When an insurance company issues a health insurance policy, they take the financial responsibility of a lifetime of hospitalisation expenses. Hence, they are very careful in giving you the policy. It is important on your part to ensure that you give every detail about your pre-existing health condition and medical history of any diseases honestly and accurately. 

Generally, insurance companies provide an annual cover close to 30-50 times the premium amount if the person buying the policy is healthy or has a moderately active lifestyle without any diseases. However, insurers think twice while issuing health insurance to someone with pre existing disease or medical history. Because, if you have a pre-existing condition or medical history, it increases the chances of you undergoing hospitalisation in the future. Hence, based on the medical details provided by you, the insurance company will decide whether they should offer you the standard deal or not.

Importance of providing accurate medical details to the insurer

Insurance is a contract of utmost good faith - it means your insurer expects you to be brutally honest in making the proposal form declarations. You should make sure you answer every question related to your pre-existing disease and medical history honestly. 

Sometimes, the insurance company would want to know the severity of the disease as well. So, ensure you provide every detail as briefly and accurately as possible. If you purposely hide or make incorrect declarations and the insurer finds out later, they can decline your claim in the future and cancel your policy altogether. 

Summing up, a pre-existing disease is not the same as your medical history. Unlike a pre-existing condition, the insurer generally doesn’t exclude your medical history from your health insurance policy. Also, you should do your due diligence and declare your medical history and pre-existing diseases to the insurance company honestly and accurately.

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Key takeaways
  1. A pre-existing disease includes any medical condition or illness that you had 48 months prior to applying for a health insurance policy.
  2. Your medical history includes every illness and disease you've had since your childhood. 
  3. If you’re buying health insurance with a pre-existing disease, you should be aware that insurers can exclude a pre-existing condition from your health plan for a certain period. 
  4. The insurer can charge higher premiums based on your medical history but can never exclude it from your health plan. 
  5. You should always provide truthful and accurate details about your medical condition to the insurer.
Aakansha Jain
Written by,
Aakansha Jain, Budding Content Developer at Beshak

Aakansha is a Content Ideator and Writer at Beshak. With her easy-to-understand content, she makes insurance simple for everyone. She comes with a strong background in finance and commerce and wants to help families make positive insurance decisions that are good for a lifetime.

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