We are all familiar with the need and importance of individual health insurance. But many first-time buyers, particularly older buyers, face a hurdle in the form of pre-existing illness exclusion clause.
Health insurers define a pre-existing illness as: ‘Any condition, ailment, injury or related conditions for which the insured had symptoms and/or was diagnosed and/or received medical advice or treatment within 48 months prior to the health policy with the company.’
Do not feel discouraged from buying health insurance because of this clause.
Importance of Health policy: Even if certain ailments are not covered, a health cover is a must. Also, pre-existing illness does not always preclude you from buying health insurance. “If an insurance seeker was suffering from an ailment four years before signing up for the policy, and it is not chronic in nature — for instance, if he had injured his leg or had his gall stones removed, there is no cause for concern.
However, if it happens to be an illness that he contracted more than 48 months ago and it has persisted, then he should declare the same,” explains Sanjay Datta, head, health insurance, ICICI Lombard General Insurance. Thereon, the decision of providing the cover, the extent of coverage and the premium to be charged is at the insurance company discretion. For instance, a patient suffering from a kidney failure is unlikely to obtain a health cover, but in case of diabetes and hypertension, the insurance company may take a call on the basis of the degree or type of illness.
Need to supplement group mediclaim: Since group mediclaim policies typically cover pre-existing illnesses as well, employees may feel tempted to avoid buying an individual cover due to insurance premium. However, it may not be a wise decision. The employer group mediclaim ceases to exist once the individual switches jobs or retires. The former may bank on the group cover offered by new employers, but retirees have no such luxury. Worse still, it would be difficult to obtain an individual cover at that age. Instead, it’s better to buy an individual policy. While group insurance would cover any pre-existing illness, the individual policy will come in handy once the waiting period comes to an end or post-retirement, thus ensuring continuous coverage for the insured. If a separate policy seems unaffordable, you could opt for a top-up plan, which gets triggered only after the basic policy’s (say the group policy) sum insured is exhausted.
Comparison of the waiting period: Individual mediclaim policies bring pre-existing diseases into the ambit of coverage, post the completion of waiting period. Therefore, apart from the insurance premium being charged by various insurers, you also need to compare the waiting periods stipulated in the policies for covering pre-existing ailments. Some policies specify a waiting period of two years, while in other cases it could extend to four years. Also, you need to check if certain conditions can be covered upon the payment of an additional premium. For instance, though New India Assurance Company’s individual mediclaim prescribes a waiting period of four years, it offers to cover diabetes and hypertension after two years, if the insured shells out extra premium.
Try to avoid switching insurers: Because of lower premiums or better terms of coverage, several policyholders look to switch over a different insurer when their policies come up for renewal. However, this could prove to be counter-productive if you are suffering from an illness. “Such policyholders should think twice before looking to move to a different health insurer. It is possible that the new insurance company could start the waiting period all over again,” says Antony Jacob, CEO, Apollo Munich Health Insurance Company. Lack of coverage for a prolonged period could defeat the very purpose of taking a mediclaim policy.
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