What You Should Know About Pre-Existing Medical Conditions and Insurance Coverage

Spread the love


Are you worried about how pre-existing medical conditions might affect your insurance coverage? This is a common concern, but understanding how insurance companies handle these conditions can help alleviate some of that stress. Let’s explore what you need about pre-existing conditions and insurance coverage.

What is a Pre-Existing Medical Condition?

A pre-existing medical condition is any health issue you had before applying for a new health insurance policy. This could be anything from asthma to diabetes, heart disease, or even something as familiar as high blood pressure. Essentially, it’s any condition in which you’ve received treatment, medication, or advice from a healthcare professional before getting insurance.

How Do Pre-Existing Conditions Affect Insurance Coverage?

It is generally observed that Insurance companies are apprehensive about providing health insurance to people with pre-existing medical conditions. 

Policyholders with pre-existing medical conditions are more likely to file a medical claim than healthy people. This increases the financial burden on insurance companies. Hence, they are likely to offer health insurance to more healthier people than people with diseases.

Also, insurance companies charge higher premiums for individuals with existing diseases. However, some companies offer insurance to people with pre-existing conditions without charge insurance. 

Waiting Periods and Exclusions

While insurance companies may not deny coverage for a pre-existing condition, they may impose waiting periods or exclusions. A waiting period is a specific amount of time a policyholder cannot file for a claim. Usually, the waiting period consists of 2 to 4 years. 

The waiting period for pre-existing diseases is not the same for all diseases. There can be variations; some diseases have a waiting period of two years, while for others, it’s four years. Changing to another insurance provider is recommended only after your waiting period. This eliminates the need to restart your waiting period when you switch insurance providers. 

Nonetheless, specific health insurance policies offer a rider that shortens the waiting period for pre-existing conditions. You can reduce the length of time by paying extra premiums. 

Exclusions mean that your insurance will not cover any costs related to your pre-existing condition for a certain period or indefinitely.

Group vs. Individual Policies – If you are investing in medical claim insurance through your employer or another group plan, pre-existing condition conditions differ from those of individual insurance. Generally, the rules regarding pre-existing conditions of group policies are more lenient than those for personal insurance and offer coverage from the start.

Tips for Dealing with Pre-Existing Conditions and Insurance

1. Read the Fine Print

Examine all terms and conditions carefully before investing in any insurance coverage, and review the exclusions, waiting periods, and pre-existing conditions.

2. Research thoroughly

Before investing in a health insurance policy, compare plans offered by other companies. Different insurance companies may have different policies regarding pre-existing conditions.

3. Be Honest

Never withhold any pre-existing conditions from an insurance application. Always disclose any underlying disease to your insurer before investing in an instance, as failure to do so will lead to medical claim rejection at later stages.

4. Understand Your Options:

If you need help finding affordable coverage due to a pre-existing condition, look into government programs or unique insurance pools available in your area.


Pre-existing medical conditions don’t have to be a barrier to obtaining insurance coverage, but it is one of the aspects which determines the cost of premiums and coverage. Hence, a healthy lifestyle is essential as it can affect your policy. You can navigate the insurance lands confidently with proper knowledge and approach. Also, read the policy in and out to know about the waiting period, limitations, and other such terms and conditions.

If you need clarification on something, you can seek professional guidance from Insurance Samadhan. We are a team of experts who offer guidance and resolutions for claims related  issues and can help you better understand your policy.

Click here to register your complaint with Insurance Samadhan

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

Visit our website: insurancesamadhan.com

Mail us at corporate@insurancesamadhan.com

Insurance Samadhan

Leave a Reply

Your email address will not be published. Required fields are marked *