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Pre Existing Disease Cover in Health insurance
A pre-existing disease (PED) in health insurance refers to any medical condition, illness, injury, or health issue that you have been diagnosed with or received treatment before purchasing the policy.
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Most health insurance plans cover pre-existing diseases only after a specific waiting period such as 1 – 3 years before you can file a claim for them. Therefore, it is important to disclose all such conditions accurately at the time of purchase to avoid claim rejections and ensure your claims are approved when you need them. PEDs can also increase your premium and may come with specific exclusions or limits, depending on the policy. Hence, choose a plan with a shorter waiting period, disclose everything upfront, and buy early, so your insurance actually covers you when you need it most.
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What is a Pre-Existing Disease?
A pre-existing disease (PED) is any illness, medical condition, or injury that a person already has before buying a health insurance policy. This can include conditions you are already diagnosed with or receiving treatment before purchasing the policy.
IRDAI states that a “pre-existing disease” in insurance is any illness you were suffering from and diagnosed within 36 months before you bought your health insurance policy.
In simple terms, if you had a health issue before your policy start date, it is considered a pre-existing disease. It can range from serious medical conditions like cancer or diabetes to conditions like high blood pressure or allergies.
Imagine you were diagnosed with asthma and started taking treatment for it. If you then buy a health insurance policy after a year, your asthma will be treated as a pre-existing disease, because it existed before you purchased the policy.
Why is Pre-Existing Diseases Coverage Important in Health Insurance?
Pre-existing disease coverage is a lifeline in health insurance, ensuring that your past health conditions don't drain your finances. Here are some reasons why having pre-existing coverage is important:
Older Adults Make More Claims for Existing Conditions
Many senior citizens (60+ years of age) end up needing hospital care for conditions like diabetes, hypertension, asthma, or heart issues (1). If the policy doesn’t effectively cover pre-existing diseases, you may still have to pay a large part of the hospital bill yourself, despite having insurance.
Chronic Disease Treatment Costs Are Rising
New research shows treatment and hospitalisation costs have increased to fivefold in 10 years (2), especially for chronic diseases like diabetes, heart conditions, and kidney issues. Without proper PED coverage, you may have to bear these rising costs entirely on your own, even if you have insurance.
Affects Your Long-Term Financial Protection
Chronic illnesses involve ongoing expenses like regular doctor consultations, continuous medication, diagnostic tests, and occasional hospitalisations over the years. If your health insurance does not have a PED cover, these repeated costs can remain largely uncovered.
What are the Common Pre-Existing Diseases Covered in Health Insurance?
The list of pre-existing conditions that are included in health insurance plans are:
| Tuberculosis | Renal Cyst |
| Diabetes | Arthritis |
| Varicose veins | Cataract |
| Chronic Obstructive Pulmonary Disease | Hepatitis |
| High Blood Pressure | Heart Disease |
| Bronchitis | Thyroid Disorder |
| Hernia | High Cholesterol |
| Malignant tumours | Asthma |
| Epilepsy | Sclerosis |
Disclaimer: The above conditions are a general representation of PED. Coverage and exclusion for these conditions may vary depending on your health insurance policy. Please read your policy document thoroughly to understand the coverage.
How Pre-existing Disease Work in Health Insurance?
Understanding how pre-existing diseases (PEDs) work in health insurance is important to know when your condition will be covered and how claims are assessed. Here’s a simplified step-by-step flow:
Step 1: Declare PED at the Time of Purchase
You must disclose any existing medical conditions when buying the policy. This includes illnesses diagnosed or treated before the policy start date.
Step 2: Risk Assessment by the Insurer
Based on your declaration, insurers may ask for medical tests or review your health history to assess risk and decide coverage terms.
Step 3: Waiting Period Begins
Once the policy starts, a waiting period applies to pre-existing diseases. During this time, claims related to the PED are not covered.
Step 4: Coverage Activation After Waiting Period
After completing the waiting period, your policy starts covering treatment costs related to the declared pre-existing disease, as per policy terms.
Step 5: Claim Assessment at the Time of Hospitalisation
When you make a claim, the insurer evaluates whether the waiting period is completed, whether the condition was disclosed during purchase, and whether the treatment falls within the coverage. If all conditions are met, the claim is processed as per the policy.
What is the Waiting Period for Pre-existing Diseases in Health Insurance?
The waiting period for pre-existing diseases (PEDs) is the time you need to wait after buying a health insurance policy, which typically ranges from 1 to 3 years, before you can start claiming expenses related to any existing medical condition declared at the time of purchase; and it depends on your health insurance provider and the kind of plan you select.
What are the Different Types of Waiting Periods in Health Insurance Policy?
There are different waiting periods in health insurance, each applied to specific conditions or situations. Understanding these helps you know when you can actually start using your policy for different medical needs.
Disclaimer: The above-mentioned waiting periods are the standard durations provided by insurers across the industry.
Our Expert Explains How Can You Reduce the Waiting Period for PED in Health Insurance
The waiting period for pre-existing diseases (PEDs) can be reduced in certain cases, but it depends on how early you plan, the type of policy you choose, and the options offered by the insurance company you choose. Here’s what you can do:
- Choose a plan designed for shorter waiting periods
- Look for add-ons in health insurance that can reduce the waiting period for PEDs.
- Renew your policy without breaks, your waiting period continues to reduce year by year. If your policy lapses, the waiting period may be reset completely.
- Buy a policy early before your health risk increases.
Remember, reducing the waiting period for pre-existing diseases is possible, but it should not be your only focus. The real goal is to ensure that your policy becomes reliable and claim-ready as early as possible, without creating gaps in coverage or overpaying unnecessarily.
Shubham Sinha
Product Manager - Health
Why is it Important to Disclose Pre-Existing Disease Before Buying Health Insurance?
Disclosing your pre-existing diseases while buying health insurance is important because it directly affects whether your claims will be approved or rejected in the future. Here’s why disclosure is critical:
- It Prevents Claim Rejection at the Time of Need: If you hide a pre-existing condition and later raise a claim, the insurer may reject your claim after verifying your medical history. Many policyholders realise this only during hospitalisation, when it's already too late.
- It Ensures You Get Covered After the Waiting Period: When you correctly disclose your condition, the insurer includes it under pre-existing diseases. It gets covered after the waiting period is completed. Without disclosure, you risk never being covered for that condition at all.
- It Helps the Insurer Design the Right Coverage for You: Your declared health conditions allow insurers to apply the correct waiting periods, set the right premium offer and suitable add-ons or coverage options in your health insurance policy. This leads to a more realistic and usable policy, not just a cheaper one.
- It Helps Determine Accurate Premiums: Insurers use your health history to assess your risk profile and calculate an appropriate premium.
- If you have disclosed your PED: you pay a fair and risk-adjusted premium
- If you haven't disclosed your PED: you may initially pay less but face serious issues later like paying out of your pocket.
What Happens When You Don’t Disclose Your Pre-existing Disease?
When purchasing health insurance, if you fail to disclose a pre-existing condition (PED), you run the risk of having your policy cancelled and facing additional penalties, such as:
- Refusal of Claim: Your insurer can reject a claim you make for a disease you did not disclose.
- Limitations on Coverage: Your coverage could be restricted even if your claim is accepted.
- Policy Cancellation: Your insurer can cancel your policy if you deliberately hide a pre-existing disease
Why Do Health Claims Get Rejected for Non-Disclosure of Pre-Existing Diseases?
Health insurance claims often get rejected due to non-disclosure of pre-existing diseases because insurance policies are issued based on the information you provide at the time of purchase. If critical health details are hidden or misreported, the insurer may consider it a breach of trust and policy terms, leading to claim denial.
This happens because:
- The policy may be issued on incorrect assumptions, which can later lead to claim rejection.
- Hiding a pre-existing disease is treated as misrepresentation, which can result in both claim rejection and loss of policy coverage.
- Even if the hospitalisation is a different issue, the claim may be denied if linked to an undisclosed condition.
For example, Mr. Rutvik bought a health insurance plan in 2021 with a 3-year waiting period, and he didn't disclose his high blood pressure problem.
Later, in 2025, Mr. Rutvik was hospitalised due to high BP and thought that his insurance company would cover the cost as the waiting period was over. However, his claim was denied since he had a PED and did not report it at the time of purchase. It means that if you don’t disclose a pre-existing disease, completing the waiting period won’t matter, your claim can still be rejected.
Also Read: What to Do if your health insurance claim is denied?
How Does Pre-Existing Disease Affect Health Insurance Policy?
A pre-existing disease affects your health insurance policy at multiple levels like influencing your premium, waiting period, coverage eligibility, and even whether your claim will be approved or rejected.
Here’s how it impacts your policy in real-life scenarios:
What are Things to Know Before Buying Health Insurance for Pre-Existing Conditions?
Before buying health insurance for pre-existing conditions, it’s important to understand that not all policies offer immediate coverage for existing health issues. Factors like waiting periods, disclosure requirements, premium loading, and possible exclusions can significantly impact when and how your policy will work for you. Here are the things you must consider before buying health insurance for PED:
- Waiting Period Can Delay Your Actual Coverage: Most policies have a 1 – 3 year waiting period for pre-existing conditions. During this time, treatment costs related to that condition are not covered, making early purchases important.
- Policies Differ in How They Handle PEDs: Health insurance plans vary in terms of waiting periods, coverage conditions, and excluded diseases. Always compare policies carefully, instead of assuming all plans treat pre-existing conditions the same.
- Not Every Medical Issue is a Pre-Existing Disease: Not all illnesses or visits to the doctor are considered pre-existing conditions. Insurers only consider medical conditions and ailments that have had a long-term effect on a person’s health.
- Hiding a Pre-existing Condition is never a good idea: We often think we should hide the facts that might hinder our chances of getting health insurance, like a pre-existing condition. However, this can lead to a reverse effect, where even if you get a health insurance policy by hiding a PED, your claim might get rejected.
- Pre-Existing Diseases Can Increase Your Premium: Insurers may charge higher premiums based on your health condition and risk level. A lower premium plan may not always be the best choice if it compromises coverage.
- Look for Add-ons That Improve PED Coverage: There are various health insurers that offer add-ons in health insurance like "Waiver of Pre-existing Condition" which reduces the waiting period to get coverage early without waiting but increases the premium.
- Some Conditions May Be Permanently Excluded: Certain policies may exclude specific pre-existing diseases entirely, meaning they will never be covered, even after the waiting period.
Do’s and Don’ts for Pre-Existing Disease in Health Insurance
When managing health insurance for pre-existing diseases, following the right do’s and don’ts can make a significant difference in whether your policy actually works for you at the time of need.
Hence, it is essential to disclose any PED at the time of purchasing the health insurance policy to avoid any future claim rejections.
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A cycling competition is held in school. All the students that sign up for the competition are told to go through a medical check-up first. One student was found to have sprained his ankle 10 days ago. So, the school tells him that he cannot participate in the competition this month – but he can come back and participate next month. That’s because the student had a Pre-Existing Condition!
Pre-existing diseases play a critical role in how your health insurance actually works in real-life situations. From waiting periods and premium impact to claim approval and long-term coverage, these conditions influence every stage of your policy journey. Simply buying a policy is not enough. What truly matters is choosing one that appropriately covers your existing health conditions. This means disclosing your medical history honestly, understanding waiting periods and exclusions, and selecting a plan that aligns with your long-term healthcare needs.
Ignoring these factors can lead to claim rejections, delayed coverage, or high out-of-pocket expenses despite being insured.
FAQs about PED in Health Insurance
Can I buy health insurance if I have a pre-existing condition?
Yes, you can buy health insurance with pre-existing disease coverage to cover any disease you have suffered (as mentioned in your policy).
How do pre-existing conditions affect health insurance coverage?
Pre-existing conditions affect health insurance coverage, resulting in high premiums, long waiting periods, multiple health checkups, and in fact policy denial.
How Does Pre-Existing Disease Affect Health Insurance Premium?
When you have a pre-existing disease, you need to buy a cover that covers PED. A higher premium can be charged for such a policy because the insurance provider is taking a chance to cover your pre-existing condition. Premium may change at purchase and renewal depending on underwriting.
What happens if you don’t disclose a pre-existing disease in health insurance?
If you don’t disclose a pre-existing disease, your claim can be rejected, and in some cases, your policy may even be cancelled. Non-disclosure of PED is treated as misrepresentation, meaning your coverage may not be valid when you need it most.
Can a claim be rejected even after completing the waiting period?
Yes, a claim can still be rejected even after the waiting period if the pre-existing disease was not disclosed at the time of purchase. Hence, you must always disclose your PED when buying a health policy.
How do insurance companies check if a disease is pre-existing?
Insurance companies determine whether a condition covered is a pre-existing disease by:
- Looking at your health report and tests
- Considering your doctor’s consultation and prescriptions
- Checking if you have undergone treatment for any disease in 36 months
Can you switch health insurance providers if you have a pre-existing disease?
Yes, you can switch insurers through policy portability in health insurance. Your completed waiting period is usually carried forward, but the new insurer may revise your premium or coverage terms based on your health condition.
What should you do if your health insurance claim is denied due to a pre-existing condition?
If your health insurance claim is denied due to a pre-existing condition. You can:
- Understand the reason for the denial
- Review your policy terms and disclosure details
- Raise a grievance with the insurer
- If not resolved, report the behaviour to IRDAI
What should you do if your health insurance claim is denied due to a pre-existing condition?
If your health insurance claim is denied due to a pre-existing condition. You can:
- Understand the reason for the denial
- Review your policy terms and disclosure details
- Raise a grievance with the insurer
- If not resolved, report the behaviour to IRDAI
Are mental health disorders considered pre-existing diseases in health insurance?
Yes, some mental health disorders are considered pre-existing conditions. If you have undergone any mental health treatment or were diagnosed with it within 3 years of your policy purchase, it is considered a pre-existing condition.
Do health insurance cover complications that arise from pre-existing diseases?
Yes, health insurance covers complications arising from PED, but only if:
- The pre-existing disease was properly disclosed
- The waiting period is completed
If these conditions are met, complications (e.g., diabetes leading to heart issues) are usually covered as per the policy terms.
Is the waiting period for coverage of pre-existing conditions negotiable?
Yes, health insurance providers may shorten the waiting period by raising premiums. These choices are made as per the agreement between the policyholder and the policy provider.
Can an insurance company refuse to cover a pre-existing condition?
Yes, an insurance company can refuse to cover a pre-existing condition in accordance with their terms and conditions.
Can I get a term insurance plan if I have a pre-existing disease like diabetes or hypertension?
Yes, you can still buy a term insurance plan if you have conditions like diabetes or hypertension, but you must disclose your health history. Insurers may charge higher premiums or have waiting periods, but hiding your illness can make your policy invalid when your family claims the money.