No insurance company can bar a person who is ill from purchasing a medical insurance policy. However, the younger and healthier a person, the more convenient it is to procure a policy. People with a pre-existing illness may face problems while trying to purchase a medical policy.
What is a Pre-existing Illness?
In health insurance jargon, a pre-existing illness is any disease that you have/have been diagnosed with prior to purchasing a medical insurance policy. It could be any ailment, ranging from lifestyle disorders like high blood pressure, diabetes to serious illnesses such as asthma.
Why are insurers disinclined towards selling a policy to a sick person?
People with a pre-existing illness are high-risk clients. They are very much likely to require medical care in the near future. That means there are high chances of them making a medical claim and if the claim is valid, the insurer would have to settle the claim. So, this is not very profitable from the insurer’s perceptive. That is why health insurance companies are unenthusiastic about selling policies to people who are ill.
But, can insurers prevent you from purchasing a medical insurance policy?
No, an insurer has no right to prevent you from getting a health policy in India. The Insurance Regulatory and Development Authority of India (IRDA) has made it mandatory for insurance companies to provide health coverage to people with pre-existing illnesses. To deny people a health scheme on the grounds that they are sick would be unlawful.
How does IRDA protect the interests of the insurers?
On the one hand, IRDA makes sure that no one is deprived of his or her right to good health. On the other hand, it also makes sure that insurers don’t suffer losses. That is why it has introduced the concept of waiting period. This means that if you have a pre-existing illness, you have to wait for a maximum of 4 years before the policy covers that particular illness. Although the waiting period may vary from one company to the next it can never exceed 4 years.
A few other guidelines you must be aware of:
A declaration of your illness
This is a strict mandate from IRDA. If you are suffering from an ailment, you have to declare it. More specifically, if you started treatment 48 months before purchasing the policy, you have to mention it in a form, even if you have been cured of it. But that does not mean that you have to declare that you are prone to small annoyances like the flu or common cough and cold. Only select diseases are included in the pre-existing illnesses list. You can ask the insurer to share a copy of the list with you.
People with pre-existing illnesses and even healthy individuals of advanced age have to undergo a mandatory health check-up before they can purchase a health insurance policy.
If you buy a health insurance policy with pre-existing illness coverage, you will have to pay a higher quantum of the premium than others do.
It is not wise to hide your illness from your insurer. If you do need medical services and it comes to light that you have been suffering from the disease since before you purchased the policy, your insurer will reject your claim.