Question: Is diabetes, hypertension or high BP, considered a pre-existing ailment? Can it lead to a rejection of claims for complications arising out of them? What happens if one didn’t know or didn’t have the condition at the time of buying the policy?
Preeti, Mumbai
Vivek Chaturvedi, CMO and Head of Direct Sales, Go Digit General Insurance
Before buying a health insurance policy, it is imperative to understand the importance of disclosing your pre-existing conditions or diseases. Insurance works on the principle of utmost good faith and therefore, it is expected of the insured and the insurer to disclose all essential information before closing the transaction.
Note that pre-existing diseases (PED) are conditions that exist at the time of buying a health insurance policy. High blood pressure, diabetes, asthma, hypertension etc., fall under PEDs and must be disclosed to the insurer when you are buying health insurance. Non-disclosure of PEDs can lead to a rejection of claims as most policies have a specific waiting period for existing diseases.
Waiting periods for pre-existing conditions could range anywhere from 1-4 years. Despite declaring your PED, insurers could still choose to cover you, perhaps at a relatively higher premium (loading). However, if one fails to be transparent, the consequences could be as harsh as the cancellation of the policy altogether. Any claim arising out of an unrelated illness also could get repudiated if the PED is discovered at the time of the investigation.
If you think you may have a PED, it’s advisable to get the relevant tests done and share the results with the insurer should you get diagnosed with a disease. This not only gives the insurer an opportunity to make necessary amends in the policy but also protects you from having your claims rejected.
Further, if you get diagnosed with a disease after buying the policy and are hospitalised for the same, your insurer will accept the claim. Note that it is also not mandatory to disclose new diseases at the time of renewing the policy because all conditions except the exclusions in the policy will be covered. However, if you choose to disclose the PED at the time of renewal (which should’ve been done while buying the policy), then the insurer may either cancel the policy or apply some restrictions or a waiting period.
Given the importance of health insurance in today’s day and age, it’s advisable to be transparent and disclose all details honestly instead of bearing the brunt of rejected claims or policy cancellations.
(Views expressed by the investment expert are his/her own. E-mail us your investment queries at [email protected]. We will get your queries answered by our panel of experts)
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