Importance of Disclosing Pre-Existing Diseases in Health Insurance

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Pre-existing medical conditions play a crucial role in obtaining health insurance coverage, impacting policy eligibility and claim settlements. Pre-existing diseases refer to an individual’s health conditions before purchasing an insurance policy. These conditions can range from chronic illnesses like diabetes, heart disease, or asthma to previous injuries or surgeries. Essentially, pre-existing diseases are medical conditions that exist before seeking insurance coverage.

For Example

Let’s take the example of someone with diabetes who buys an insurance policy. When the policy starts, they will be covered for all illnesses except diabetes, but that coverage for diabetes will only begin after a waiting period. This waiting period, mentioned in the policy document, can be anywhere from two to four years. It’s important for the policyholder not to hide their health condition when buying the policy because it can cause problems when they need to make a claim later on. Instead, they should be honest about their pre-existing disease and understand that they will be covered for it, but they may have to wait for a certain period of time before the coverage starts.

Navigating Pre-Existing Diseases in Life and Health Insurance

Can You Get Insurance with a Pre-existing Disease 

Let us understand the scenario of health insurance.

Health insurance coverage for pre-existing diseases is typically subject to a waiting period. During this waiting period, if a policyholder becomes ill and requires hospitalization due to their pre-existing disease, the health insurance policy will not provide coverage for that specific condition. However, the policy will eventually start covering the pre-existing disease if no significant health issues arise during the waiting period. The waiting period for coverage of pre-existing diseases commonly falls within 2 to 4 years. Policyholders need to be aware of and understand the waiting period specified in their health insurance policy to ensure they clearly understand when coverage for their pre-existing condition will begin.

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Importance of Disclosing Pre-existing Diseases

When applying for insurance, it is of utmost importance to disclose any pre-existing diseases accurately and completely. This step is crucial for several reasons. Firstly, it ensures transparency between the policyholder and the insurance company. By providing honest information about pre-existing conditions, the policyholder establishes trust. Furthermore, disclosing pre-existing diseases enables the insurance company to assess the associated risks accurately. Insurance companies rely on this information to determine the appropriate coverage, premiums, and policy conditions. 

Adhering to this leads to smooth claim processing, reducing the chances of claim rejection or delay. If your insurance claim is still rejected, you can contact Insurance Samadhan. We will be happy to help you. Till date, we have helped 15,000+ people in resolving insurance claim-related cases. We are always here to help you!

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Bottom Line 

Disclosing pre-existing diseases is vital for smooth insurance claims, accurate risk assessment, and suitable coverage options. Non-disclosure can lead to claim rejections and financial burdens. Being honest is a fair and trusted relationship between insurers and policyholders. Remember, honesty is the best policy for securing reliable insurance coverage.

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Also Read:  Things you should know about Health Policy renewability

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Shikhar Vashisht


  1. Since the lock in period of PED exhausted/expired and the Patient/Client was not aware about PED, he/she could only realise on information from Doctor, the Claim must be Considered positively.

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