Disclosure Pre-existing diseases if taking health insurance

Disclosure Pre-existing diseases when taking health insurance

Overview of the disclosure requirements for pre-existing diseases when applying for health insurance in India, along with the rules on moratorium period and waiting period as per IRDAI guidelines.

Pre-existing diseases are medical conditions or illnesses that insured person was already suffering from at time of purchasing health insurance policy. Most health insurance plans do cover pre-existing diseases, but only after a waiting period—typically 2 to 3 years from Policy start date. Some special plans offer PED coverage from Day 1, but these are limited and often come with higher premiums or stricter conditions. If a claim is made during the Pre-existing diseases waiting period for treatment related to a pre-existing condition, it will likely be rejected by the insurer.

Valid Claim Settlement Starts with Full Disclosure

Failing to disclose PEDs can lead to claim rejections. Insurance companies assess risk and determine coverage based on the information you provide. If they discover that you withheld relevant medical details, your claim could be denied—leaving you fully responsible for medical expenses.

Policy Cancellation Risk

Non-disclosure of Pre-existing diseases can lead to policy cancellation. If your insurer finds out that you intentionally hid critical health information, they have the right to terminate your policy—often when you need it most.

Legal Consequences

Withholding medical history is a breach of contract. In serious cases, insurers may initiate legal proceedings, especially if fraud is suspected.

Higher Premiums vs. Denied Coverage

Disclosing Pre-existing diseases might result in higher premiums, but this is a fair exchange for reliable coverage. Being upfront ensures your policy remains valid and your claims are honoured when needed.

Peace of Mind

Transparency brings peace of mind. Knowing your policy is based on full disclosure ensures support in medical emergencies without surprises.

IRDAI guidelines & rules – Disclosure Requirement on moratorium period and waiting period 

• Mandatory to disclose: Chronic diseases, Serious illnesses requiring hospitalization

• Not necessary to disclose: Minor ailments (e.g., cough, cold, fever)

• Always make all relevant disclosures and let the insurer decide on coverage.

How Far Back Must You Go?

• No fixed time limit on how far back your medical history must go.

• Any relevant past history (even childhood surgeries like kidney removal) must be disclosed.

Moratorium Period

• First 5 years: Insurer can take action for non-disclosure of Pre-existing diseases.

• After 5 years: Policy cannot be cancelled or claim rejected for non-disclosure (unless fraud is proven).

• Fraud Exception: Insurer can act even after 5 years if fraud is established.

Waiting Period

• 36 months (3 years) from policy start date is the standard waiting period for Pre-existing diseases as per IRDAI.

• Diseases diagnosed before policy inception may be covered after 3 years.

• Some insurers may reduce waiting period for an additional premium.

How to Disclose Pre-Existing Diseases

Honesty Is the Best Policy : Disclosing pre-existing conditions is both a legal obligation and a wise financial move. It ensures your health insurance serves its purpose—protecting you during medical emergencies. Being transparent now helps you avoid complications later. When applying for health insurance, provide accurate and detailed information about:

• Diagnosis Date – When the condition was first identified

• Treatment History – Surgeries, therapies, or hospitalizations

• Current Medications – Ongoing prescriptions or therapies

• Doctor Consultations – Frequency and nature of visits

Consult your doctor and gather updated medical records to submit with your application. You should disclose At the time of application – All known medical conditions, past treatments, surgeries, or chronic illnesses. and During the policy period – Any significant health updates such as new diagnoses, surgery, or long-term medication changes should also be informed.

Choosing the Right Policy

When selecting a policy, keep the following in mind:

• Waiting Period: Typically 36 months for Pre-existing diseases to be covered

• Coverage Limits: Ensure adequate coverage for your known conditions

• Network Hospitals: Choose policies with hospitals that support your treatment

• Premium Costs: Compare insurers to balance affordability with benefits

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