Individuals, especially senior citizens, should take an add-on policy that covers pre-existing diseases such as asthma, hypertension, diabetes from day one by paying an extra premium. This will ensure comprehensive coverage for health conditions that require regular check-ups, treatment and reduce the out-of-pocket expenses.
Pre-existing diseases such as diabetes and hypertension are now quite common across all age groups due to sedentary lifestyles. The coverage for such pre-existing diseases eventually starts after a waiting period of three to four years.
Reduction in wait period
Recently, the insurance regulator has reduced the waiting period for pre-existing diseases in health insurance to 36 months from 48 months. Insurance companies cannot reject any claim on the grounds of pre-existence of ailment after three years of issuing the policy. In fact, almost all health insurance plans have an initial waiting period of one month during which no claims are accepted, except for accidental cases.
Siddharth Singhal, head, Health Insurance, Policybazaar.com, says, the waiting period acts as a barrier for people with such ailments to opt for health insurance. However, day one cover helps bridge this gap. “It makes sure that you are covered against pre-existing diseases immediately after the initial 30 days period. It is advisable, especially for senior citizens, to take a policy with the shortest waiting period.
Similarly, Pankaj Goenka, business head, InsuranceDekho, says for individuals with pre-existing diseases, it is advisable to opt for a policy with a minimum waiting period, even if this requires a 10-15% increase in the base premium. “By paying an extra 10-15%, policyholders can ensure they have the necessary coverage without unnecessary delays,” he says.
The premium difference between an add-on policy offering immediate coverage for pre-existing conditions and a policy with standard waiting period will depend on factors such as the insured’s age, the specific pre-existing condition, the sum insured and even the location.
Disclose health conditions
Policyholders must accurately declare their health condition. By presenting all relevant facts about their pre-existing diseases to the insurer, policyholders can secure coverage from day one. Once the insurer provides this coverage, there are no exclusions related to the declared pre-existing conditions. Often, waiting period reductions are allowed for slow-growing diseases, but not for critical conditions like cancer.
However, individuals must note that in day-one covers there might be certain exclusions. “These can include specific treatments or procedures related to pre-existing conditions, cosmetic surgeries, non-essential medical treatments, and conditions not disclosed during the application process,” says Rakesh Goyal, director, Probus Insurance Brokers. So, it is crucial to thoroughly read the policy terms and conditions to understand exclusions to avoid surprises during claims.
Points to consider
Foremost, an individual must note that a higher premium for the add-on cover fits within his budget. He must consider the long-term affordability of the premiums as health insurance is a recurring expense, and he needs to ensure that he can maintain the policy over the years. He must check if there are any sub-limits on treatments for these conditions and verify that there is no capping on the claim amount for related pre-existing diseases. This can affect the overall coverage.
An individual must choose a reputable insurer with a good claim settlement ratio and customer service to ensure a smooth process in times of need. By addressing these points, individuals can secure a policy that provides a better claim experience without any hassles.