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 Comprehensive Information on Pre-Existing Medical Conditions in Health Insurance

Life is so volatile that one can never be safe enough from the hazards of time. There is a safe space for such instances in your life, and it is having health insurance. Thousands of people are diagnosed with dangerous diseases like cancer or tumours every day.

There is a concept of pre-existing medical conditions when we talk about health insurance. The journey through the health insurance landscape is very confusing when it comes to pre-existing diseases.

But with the development in the insurance industry, we have seen various provisions supporting this situation. It is true that it might get a little complicated to get health insurance coverage for pre-existing conditions.

This medical coverage allows you to lead a stress-free time regarding financial issues, even with the health condition you have. This is because of various advantages it offers like health insurance tax benefits, coverage for a certain condition that is bound to arise, financial assistance, recommended hospitals, etc.

But buying this coverage might be a huge task. In this blog, let us discuss the concept in depth.

 Old Definition of Pre-existing Medical Conditions

In the recent past, pre-existing medical conditions were defined as the medical diseases like cancer and diabetes that a policyholder had before seeking or issuing health insurance. The conditions start showing after the span of three months of buying the policy.

This traditional definition allows insurers to deny claims for that specific condition. This also made it difficult for policyholders with chronic illnesses to access affordable and comprehensive health insurance plans.

 New Definition of Pre-existing Medical Conditions

On 10th February 2020, the Insurance Regulatory and Development Authority (IRDAI) made a few changes to the definition of the term pre-existing conditions. When the disease or the sickness is diagnosed before seeking or issuing health insurance, that condition is termed as a pre-existing condition in the context of an insurance policy. The sickness should be diagnosed at least 48 days prior to the purchase of the plan.

 Features of Medical Covers for Pre-Existing Conditions

Medical coverage for pre-existing conditions is when the health insurance policy provides coverage for a disease or a condition the policyholder possesses and diagnoses before issuing the policy.

Let us look at the features of this coverage provided by the health insurance policy.

  • High Premiums

When insurance companies cover a certain thing in life, it is for the safety of the policyholder and the family. It never covers certainties because then the probability of the policyholders raising a claim becomes 100%. This is risky for the company.

Since the pre-existing condition is covered by the insurance policy, it is a risky transaction for the insurance company, and hence, the insurance is on the heavier side of the scale.

  • Longer Waiting Period

Another important feature that shapes the medical cover for pre-existing medical conditions is they usually have a longer waiting period. Insurers may require individuals to wait before certain benefits become effective.

These benefits include coverage for specific treatments related to their pre-existing conditions. The waiting period for your specific condition will be mentioned in the terms and conditions of your policy since every case is unique, and every policy caters to the policyholders dynamically.

  • Medical Check-ups

In some cases, insurers request medical check-ups or examinations before providing coverage for individuals with pre-existing conditions. The coverage provided by the insurance company allows the policyholders to cover the finances of these necessary medical check-ups.

  • Exclusion from Policy

Sometimes, the insurance company can completely exclude that particular health condition from your insurance coverage. This means the health insurance policy will cover any other medical condition arising that does not include the pre-existing condition.

 How to Buy Health Insurance with a Pre-Existing Disease?

  1. Step 1 would be comparing various insurance companies and policies for yourself or your family member (concerned person). You can buy insurance online as well as offline with leading insurers like Tata AIG. However, the online purchase is quicker than the offline one.
  2. The company will ask for all the relevant personal and professional details for policy purposes. These details will consist of name, age, gender, government ID proof, profession, address, and medical certificate.
  3. Submit the medical test mentioning the pre-existing medical disease.
  4. The policy will go under review with the company staff and officials.
  5. If the policy is accepted, the premium will be raised due to the medical condition. (There are chances that the policy might get denied due to the same reason!)

 Things To Remember

Remember these factors about the pre-existing medical conditions and health insurance before buying the policy:

  • Do not hide a pre-existing illness from the insurer. You won’t receive any benefits for raising a claim in such cases.
  • Different policy providers have different policies, so it is advised to compare the insurance plans available in the market before putting your trust in one place. Choose the one with lower cost and better benefits.
  • You must avoid health insurance plans that promote and offer co-payment on the treatment expenses of a pre-existing disorder.
  • Every provider offers a different waiting period and a varying degree of coverage. So, compare the policies and choose the policy that offers a lower waiting period on the policy with the benefits you prefer.


The landscape of health insurance that covers pre-existing conditions has seen a lot of transformation in the past years with the help of IRDAI. It moved from a restrictive and often discriminatory approach to a more inclusive and fair system. There are still a few complications and exclusions, but it is possible to get medical coverage for pre-existing medical conditions.


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