Are Pre-Existing Diseases Covered After 3 Years?

Vote: 1

Pre-existing lifestyle diseases such as diabetes and hypertension are increasingly becoming common in young people of India. In this context, many people think that 'what is the point of investing in health insurance if I will not get any coverage for the pre-existing conditions?'


Although it is a valid question, health insurance policies have reduced the waiting period for PED from 4 years to 3 years. Let’s understand the new rules and how you can benefit from them.


Pre-Existing Disease Coverage Explained


Historically, most health insurance providers in India mandated a 3 year (36-month) waiting period for pre-existing diseases. You had to hold the policy continuously for 4 years before you could claim a single rupee for those specific ailments.


However, effective April 1, 2024, the Insurance Regulatory and Development Authority of India (IRDAI) introduced a massive update that benefits you (policyholder) directly. The body revised the maximum waiting period to 3 years or 36 months.


How Does Pre-Existing Disease Waiting Period Work?


It is important to understand that PED coverage is not automatic from day 1. Insurance companies use waiting periods to prevent people from buying a policy only after they get sick.



  • 0 to 3 Years:You are in the waiting period. If you are hospitalised due to your pre-existing condition during this time, the insurer will generally not pay the claim. However, if it is a life-threatening situation, then insurers may reach a middle ground.



  • After 3 Years:In order to get coverage for your PED, you have to continuously renew the policy on time. You can utilise your no-claim bonus to get discounts. After 3 years, you can make a claim for treatment of PED.



  • After 4+ Years:You are well within the safe zone.


Note: Some premium plans offer even shorter waiting periods of 1 or 2 years. However, the insurer may charge an extra premium for the added liability.


What Actually Counts as a Pre-Existing Disease?


Many people face confusion as they do not know what counts as PED. You don't need to declare every cold or fever you've ever had.


IRDAI defines PED as:



  • A physician diagnosed any condition, ailment, injury, or disease up to 48 months before you bought the policy.



  • Any condition for which medical advice or treatment was recommended by or received from a physician up to 48 months prior.


For example, if you suffered from a condition 10 years back and fully recovered from it, then your insurer may not consider it a pre-existing disease. However, you must declare such incidents so that there is no non-disclosure on your part.


Final Words


To get coverage for pre-existing diseases, you need to build trust and loyalty with your insurer. You can do that by taking part in wellness programs and keeping yourself healthy.


Once the insurer sees that you have diligently renewed the policy and waited for 3 years, they will start covering the conditions. Until then, build a safety pool for treatments related to PED.