Health Insurance Plans With Shorter Waiting Periods For PEDs!
- Introduction
- What is A Pre-Existing Disease?
- Pre-Existing Diseases And Waiting Periods
- Conditions Related To Pre-Existing Diseases
- Insurance Companies With Lower Waiting Periods For PEDs
- Caution: Keep This In Mind!
A beautiful apartment is up for sale. With spacious interiors and quality finishes, this cosy abode is the perfect place to call home. Before you pitch in your money, you want to make sure that it has a reliable water supply, the amenities meet your expectations, the electricity is up to code, and the community is a good fit for you. This can give you insight into the potential value of the investment and help you decide whether the apartment is worth the price or whether you should wait for a better opportunity.
Similarly, when you apply for a health insurance plan, your insurer will require a detailed understanding of your health condition, the medical history of any diseases or injuries, and any pre-existing diseases. This is because insurers assume the financial responsibility for hospitalisation expenses for the rest of your life when you apply for a policy. They need this information to determine the potential cost of providing health insurance to you and assess the risk involved. The more information they have, the better equipped they are to assess the risk and financial implications.
A pre-existing disease refers to any condition, ailment, injury, or disease diagnosed or treated by a doctor within 48 months before the date of issue of your health insurance policy.
For instance, Rohan, 30 years old, contracted tuberculosis two years ago. His doctor prescribed him medication as well as a healthy dietary regimen. Following the prescribed course enabled him to make a full recovery, with no residual effects of the disease. If he buys a health insurance policy now, the insurer will consider tuberculosis as a pre-existing disease. Generally speaking, PEDs are medical conditions that existed within 48 months before the purchase of the policy. So, even though he has already recovered from the condition, it still counts as a preexisting disease.
A waiting period is a specific time frame during which insurance companies will not cover any expenses related to medical treatments or illnesses, including pre-existing conditions. You can file a claim for such expenses only after serving the waiting period.
Pre-existing conditions are subject to a waiting period of 2-4 years. Let's say Rohan’s health insurance plan has a two-year waiting period for pre-existing diseases. Let’s assume that tuberculosis recurs in the first year after his policy is issued and he needs hospitalisation to treat the same. In this case, the insurer will not cover the expenses associated with his medical treatment.
For keeping claims under control, and hence, keeping the health insurance plan affordable, a health insurance plan does not cover certain medical conditions or treatments for a specific time span when you buy it. Waiting periods protect the insurance company from shouldering too much financial risk.
As mentioned earlier, insurers require a complete understanding of your health status and medical history of any diseases or injuries as accurately as possible before offering you coverage. This is done so that they can accurately assess the risk of insuring you and determine the premiums they are going to charge.
And, generally, insurance premiums are determined based on the assumption that the person buying the policy is healthy and living an active lifestyle without any diseases. If you have a health condition or medical history, you are more likely to need frequent hospitalisations.
Consequently, insurers may put these additional conditions on your policy based on your declarations and health conditions -
1️⃣ Increase Premiums
Insurers can apply a loading i.e. an extra premium, usually 10% to 50%, to standard premiums to balance the increased risk associated with your declarations.
2️⃣ Impose Permanent Exclusions
Some pre-existing diseases can have a long-term effect on health and sometimes can even recur. Recent IRDAI guidelines on standardising health insurance have allowed insurers to permanently exclude certain illnesses for which they previously declined coverage. Like cancer, epilepsy, heart ailment, stroke, liver disease, etc.
3️⃣ Decline The Policy
Some pre-existing conditions may be too complex for insurers to estimate the associated risk. So, they may decide not to insure you and decline your proposal.
4️⃣ Impose Restrictions
An insurer may impose restrictions, such as an additional copay for every claim, on certain chronic conditions. This is done to mitigate the potential financial implications of covering such conditions.
Besides these limitations, there are some positive aspects as well. Some insurers have started offering coverage for specific PEDs with shorter waiting periods.
People living with PEDs for a long time may require frequent hospitalisations. If they need medical help during the waiting period, they may incur out-of-pocket expenses. The fact that they need to shell out their money despite being covered doesn't make sense. As a response to this concern, insurers have come up with innovative features that offer shorter waiting periods.
Shorter waiting periods alleviate a great deal of worry for those living with such conditions for a long time. They can finally relax knowing that they can get timely medical care. Although these insurers offer shorter waiting periods for PEDs, the extent of coverage may vary.
Here’s a compilation of different insurers and their coverage related to PEDs -
| Pre-Existing Disease | Insurance Plan | How does it cover this disease faster? | Fine Print |
|---|---|---|---|
| Asthma | Aditya Birla - Activ Health Platinum | Covered from Day 1 | Hospitalisation expenses are not covered. Only OPD expenses are covered. |
| Care Insurance - Care Supreme (with Instant Cover Rider) | Covered from Day 31 | - | |
| Manipal Cigna - ProHealth Prime Active | Covered from Day 91 | - | |
| Royal Sundaram - Multiplier | Covered from Day 31 | - | |
| Diabetes | Aditya Birla - Activ Health Platinum | Covered from Day 1 | Hospitalisation expenses are not covered. Only OPD expenses are covered. |
| Care Insurance - Care Supreme (with Instant Cover Rider) | Covered from Day 31 | - | |
| Manipal Cigna - ProHealth Prime Active | Covered from Day 91 | - | |
| Niva Bupa - ReAssure 2.0 (with Disease Management Rider) | Covered from Day 1 | - | |
| Royal Sundaram - Multiplier | Covered from Day 31 | - | |
| Dyslipidemia | Manipal Cigna - ProHealth Prime Active | Covered from Day 91 | - |
| High blood pressure | Aditya Birla - Activ Health Platinum | Covered from Day 1 | Hospitalisation expenses are not covered. Only OPD expenses are covered. |
| Royal Sundaram - Multiplier | Covered from Day 31 | - | |
| High cholesterol / Hyperlipidemia | Aditya Birla - Activ Health Platinum | Covered from Day 1 | Hospitalisation expenses are not covered. Only OPD expenses are covered. |
| Care Insurance - Care Supreme (with Instant Cover Rider) | Covered from Day 31 | - | |
| Royal Sundaram - Multiplier | Covered from Day 31 | - | |
| Hypertension | Care Insurance - Care Supreme (with Instant Cover Rider) | Covered from Day 31 | - |
| Manipal Cigna - ProHealth Prime Active | Covered from Day 91 | - | |
| Niva Bupa - ReAssure 2.0 (with Disease Management Rider) | Covered from Day 1 | - | |
| Obesity-related conditions | Manipal Cigna - ProHealth Prime Active | Covered from Day 91 | - |
*Source: Beshak Research Desk
These benefits give you immediate financial assistance and protection for expenses related to these pre-existing conditions. So, if unexpected medical expenses arise, there is something to cushion the blow and keep you from hitting hard times.
If you’re considering buying plans with these features, you should evaluate if they are in-built or available as an add-on. And, if such features are available as add-ons, make sure you select them at the time of purchase.
Like the saying "the grass is always greener on the other side"; these features may appear useful and appealing, from the outside. But, it may not always be the case when you get closer - there may be shortcomings that are not immediately visible.
A few other things you should be aware of before you opt for such benefits -
👉Not All PEDs Come With Shorter Waiting Periods
When deciding whether to purchase a plan with such benefits, you should also keep in mind that these plans apply the shorter waiting period only to a limited list of PEDs. All other PEDs are subject to a waiting period of 2-4 years. As such, it is important to read the fine print and check the list of PEDs covered by the plan.
For instance, Raj decides to purchase a health insurance policy. He is an asthma patient and has been receiving medical treatment for the past few years. A couple of years ago, he got diagnosed with 1st stage lung cancer and was successfully treated with surgery. As per the policy’s conditions, both asthma and cancer will be considered as pre-existing conditions. He chooses a health insurance policy that imposes a 2-month waiting period for PEDs like asthma and blood pressure and a 2-year waiting period for all other PEDs.
Now, let’s consider two case scenarios-
Scenario 1: Raj gets hospitalised due to an asthmatic attack 6 months after purchasing the policy.
In this case, the insurer will take care of the medical expenses, since the 2-month waiting period is over.
Scenario 2: Raj gets hospitalised for cancer again in the 1st year of buying the policy.
In this case, the insurer will not provide coverage, since the 2-year waiting period is still active.
👉The Insurer May Not Cover Hospitalisation Costs
Insurers like Aditya Birla will not cover hospitalisation expenses related to PEDs under their program. They will only cover the costs of managing the listed diseases like pharmacy costs, physician consultations, diagnostic tests performed at outpatient clinics, physician or diagnostic facilities, etc.
Insurance policies are complex documents, and what you see on the surface may not reflect the real coverage and benefits. It is like trying to navigate a maze; on the surface, the path may look straight, but there are often hidden turns and unexpected dead-ends that can leave you lost and confused. Therefore, it is important to carefully read the fine print to understand what is included and excluded in the policy and make an informed decision.
Feeling overwhelmed with these features and want to unravel them? Go for Beshak’s Free 1-To-1 Consultation and talk to an experienced financial advisor of your choice!
- Pre-existing conditions are subject to a waiting period of 2-4 years. You can claim these pre-existing conditions after the waiting period is over.
- Insurers have now started offering coverage for specific PEDs with shorter waiting periods.
- Some products that have this feature include Manipal Cigna ProHealth Prime Active, Royal Sundaram Multiplier Policy, Niva Bupa ReAssure 2.0, Aditya Birla Activ Health Platinum, Care Insurance Care Supreme, etc.
- However, there can be some drawbacks to these benefits, such as short waiting periods only for a limited list of PEDs, coverage of only hospitalisation expenses, etc.
- Before opting for such benefits, ensure you read the policy wordings carefully.
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