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What is Pre-Existing Condition in Health Insurance

What Is A Pre-Existing Condition In Health Insurance?

When you buy a health insurance online or offline, you will come across the term ‘pre-existing condition’. It simply means a personal illness or health condition that was known and existed before safeguarding your family or yourself with a health insurance. This can include serious health issues such as cancer, diabetes to less serious illness like asthma or blood-pressure. Health insurance companies evaluate an individual's pre-existing conditions before signing the contract and provide a waiting period accordingly.

 Insurance providers do not cover illnesses that are already known to exist as these individuals would require frequent medical assistance and this poses a higher financial risk to the insurance company.  For instance, if you have an existing illness that has not be declared then the insurance company would not cover for it. Similarly, an insurance company will not cover for an illness that already exists.

Breaking Down Pre-Existing Condition:

Difference In Health Policies

While selecting a plan, understand the terms and conditions of pre-existing coverage from various insurance providers as it will differ from one provider to another. Typically it is difficult to get a cover for pre-existing ailments, but there are some exceptions to it. Some insurance providers will consider an individual’s medical history from the beginning till date while some may only consider a period of the last 4 years.

The Vital Factor

Never hide a pre-existing condition. It is important to mention about any medical conditions before signing up for a health insurance plan.  Any existing condition found to be present in the later stages of verification by the insurance company, may lead to a rejection of your claim.

You Can Get Coverage For Pre-Existing Conditions

Individuals are often under the impression that insurance providers do not provide cover against pre-existing ailments. You should be aware that policies differ from one insurer to another. Currently, a waiting period is provided for health insurance policies where the provider will not cover the costs of treatments, doctor visit fees, medicines, etc. incurred by the insured pertaining to his known medical condition. These costs will be covered only after the waiting period is over. However, the policy will cover expenses on other illnesses, which are covered under the policy.

Not Every Visit To The Doctor Is Counted

If you are under the impression that your frequent trips to your doctor for cold, cough, fever is considered while applying for health insurance, then you are wrong. Insurance providers only consider medical ailments which have long-term impacts  on an individual’s health.

Reduction In The Waiting Period

A waiting period for a health plan totally depends on the insurance provider. For example, some companies have a waiting period of 2 years while some may stretch it to 4 years. If you feel the need to shift to another insurer, do so only after you have completed your waiting period. In the recent times, some policy providers have also allowed individuals to cut down on their waiting period in return for extra premium payment.


Select a health plan that suits your needs and understands its terms and conditions before investing your hard earned money in it.