What to Know About Insurance Coverage for Pre-existing Medical Conditions

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An Overview 

Health insurance is a vital component of financial planning, ensuring that you are prepared for unexpected medical expenses. In India, where healthcare costs are rising steadily, having health insurance coverage is essential. However, for individuals with pre-existing medical conditions, obtaining insurance can be challenging. In this blog, we will explore the key aspects of insurance coverage for pre-existing medical conditions in India and provide you with valuable insights to make informed decisions.

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What is meant by Pre-existing disease?

A pre-existing medical condition refers to any health ailment that exists in the insured individual prior to obtaining an insurance policy. To illustrate this, suppose you received a diagnosis of hypertension in 2020, and you are now purchasing an insurance policy in 2023; in this case, hypertension would be categorized as your Pre-Existing Disease (PED).

Are PED’s covered in health insurance plans?

PEDs are typically covered under health insurance plans, but there is usually a waiting period specified in the policy. Therefore, it’s advisable to choose an insurance policy with a shorter waiting period for PED coverage.

However, if you already have an existing policy that you recently transferred to a different insurer through portability, the waiting periods for PEDs are often waived or only the remaining portion of the waiting period applies to the new policy. This can be beneficial for policyholders as it ensures continuity of coverage for their pre-existing conditions.

In the case of corporate insurance policies, PEDs are generally covered from day one, and waiting periods may not apply. Corporate insurance plans often offer more extensive coverage options to employees without the waiting period limitations commonly found in individual policies.

It’s essential for individuals to thoroughly review the terms and conditions of their insurance policies, including the waiting periods for PED coverage, to make informed decisions about their health insurance needs.

What will happen if I hide my PED from the insurer?

If your intention is to conceal your PED from the insurer, thinking that they won’t find out and your claim will be approved, you are mistaken. It’s imperative to always disclose your PED to your insurer because failing to do so goes against the fundamental principle of utmost good faith in insurance. Concealing your PED can result in the cancellation of your policy and the forfeiture of any continuity benefits offered. While disclosing your PED may lead to an increase in your premium, it is the ethical and responsible course of action.

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There might be certain instances where you would have disclosed the PED yet the insurance company has failed to declare the same in the policy copy, this might also lead to rejection of your claim, hence always be aware that your PED is disclosed in the policy. Also, many times agents fill the proposal form for insured members, here also the agents fail to mark the PED in the proposal therefore, you must always cross check in detail that PED is marked and ensure that it has been disclosed in the policy document.

In some cases, you may have provided information about your PED to the insurance company, but they might have inadvertently omitted it from the policy document. This oversight could potentially result in the denial of your claim. It’s crucial to be vigilant and ensure that your PED is correctly declared in the policy document. Additionally, it’s worth noting that agents often assist in filling out proposal forms for insured members, and in such instances, there is a chance that the agents might overlook marking the PED. Therefore, it’s advisable to thoroughly review the proposal form to confirm that your PED has been accurately noted and disclosed in the policy document. This attention to detail can prevent complications and ensure that your insurance coverage is comprehensive and accurate.


In conclusion, health insurance is a critical aspect of financial planning in India’s rising healthcare landscape. PEDs are an important consideration when choosing coverage. It’s essential to understand that PEDs can be covered but often come with waiting periods. Concealing PEDs is not advisable, as it violates the principle of good faith and can lead to policy cancellations. Moreover, it’s crucial to double-check that your PED is accurately disclosed in the policy document, as oversights can lead to claim denials. Being diligent ensures comprehensive and accurate insurance coverage for your needs.

By Shivani Modi

Also Read:  What features to look for while buying health insurance?

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