A simple guide for people with diabetes, high blood pressure, thyroid issues, asthma, or any other health condition.
Many people think, “I already have a health problem, so no company will give me insurance.” This is not true. You can get health insurance with a pre-existing condition, and many insurers offer it. You just need to know a few things before you apply.
In this guide, we explain how to buy a health policy when you already have a medical condition, such as diabetes or high blood pressure. First, we cover the basics. Then, we share simple steps, an example, and answers to common questions.
What is a pre-existing disease?
A pre-existing disease (PED) is any health problem you already have before you buy a policy. It can be something you were diagnosed with, or something you are taking treatment or medicine for.
Common examples:
- Diabetes
- High blood pressure
- Thyroid problems
- Asthma
- Heart disease
- Kidney problems
Can you get health insurance with a pre-existing disease?
Yes, in most cases you can get a medical insurance policy, even with an existing illness. However, there are some things to expect:
- The company may ask you more questions and ask for medical tests.
- The premium (the amount you pay) may be a little higher.
- Your pre-existing disease will not be covered right away. You have to wait for some time. This is called the waiting period.
What is a waiting period?
The waiting period is the time you must wait before the policy pays for treatment of your pre-existing disease.
For example, if your waiting period is 3 years, and you have diabetes, the insurer will not pay for diabetes treatment in the first 3 years. After that, it will be covered.
Other illnesses that are not pre-existing, like a sudden accident or a new infection, are usually covered much earlier.
What is the moratorium period?
After you have kept your policy running for 5 continuous years, the insurer generally cannot reject your claim just because you did not mention some health condition earlier. This is called the moratorium period. (Fraud is an exception.)
So, renew your policy on time and never let it lapse.
What details and documents will the insurer ask for?
When you apply, the insurer wants to know your full health picture. Keep these things ready so your application does not get delayed:
- Name of your condition and the year it was first diagnosed
- Current medicines and their dose
- Recent test reports, such as blood sugar (HbA1c), blood pressure readings, thyroid tests, or X-ray and scan reports
- Past surgeries or hospital stays, with the dates
- Doctor’s prescriptions or discharge summaries
- Lifestyle details, such as smoking, alcohol, height and weight
Based on this, the insurer will take one of these decisions:
- Accept the application at the normal premium.
- Accept with a higher premium (this is called a loading), because your risk is higher.
- Accept, but exclude one condition permanently or for a longer period.
- Decline the application. This is rare for common conditions, and you can try another insurer.
Which type of plan should you look at?
You have more than one option. Here are the main ones:
- Regular individual or family floater plan. The most common choice. Your pre-existing disease gets covered after the waiting period.
- Disease-specific plan. Made for people with diabetes, heart disease, or high blood pressure. These plans may cover your condition sooner, but the premium is usually higher.
- Top-up or super top-up plan. A low-cost plan that pays only after your bills cross a set limit. Good for adding extra cover on top of your main plan.
- Employer (group) cover. If your company gives you health insurance, check the rules. Many group plans cover pre-existing diseases from the first day. Remember that this cover usually ends when you leave the job, so a personal plan is still important.
Can you switch insurers? Yes, with portability
If you already have a policy and want to move to a better one, you can use portability. You can shift to a new insurer at the time of renewal and ask for credit for the waiting period you have already completed. Apply at least 45 to 60 days before your renewal date, because the new insurer will check your details again and may accept or reject the request.
7 simple steps to buy a health insurance policy with a pre-existing condition
1. Be honest in the form
2. Buy as early as possible
The waiting period starts from the day your policy begins. The earlier you buy, the sooner your waiting period ends. Do not wait for a hospital visit to think about insurance.
3. Compare waiting periods, not just price
For instance, two plans may have the same premium but very different waiting periods. A plan with a 2-year waiting period can be better than a cheaper plan with a 3-year waiting period.
4. Check what is not covered
Read the “exclusions” section. Some plans may permanently exclude one specific condition. Know this before you buy.
5. Look for plans made for your condition
Some companies offer special plans for people with diabetes, heart problems, or high blood pressure. These plans may cover your condition from an earlier date, though the premium can be higher.
6. Be ready for a medical check-up
The insurer may ask for blood tests or a doctor’s report. Keep your old reports and prescriptions ready. As a result, the process becomes faster.
7. Renew on time, every time
If your policy lapses, you may lose the waiting period you have already completed. Set a reminder or turn on auto-renewal.
A simple example
This is an example only. Your plan’s rules may be different.
Ravi is 42 years old and has had diabetes for 5 years. He buys a health plan with a 3-year waiting period for pre-existing diseases. He shares all his details honestly and pays a slightly higher premium.
- In year 1: Ravi has a road accident and needs surgery. The plan pays, because an accident is not related to his diabetes.
- In year 2: He is admitted for a complication caused by diabetes. The claim is not paid, because the waiting period is still running.
- From year 4: Diabetes-related hospital treatment is covered.
- After year 5: The moratorium period is complete. His claims cannot be rejected for non-disclosure, except in case of fraud.
The lesson is simple. Ravi bought early, was honest, and renewed on time every year. That is why he is fully protected today.
Common mistakes to avoid
- Hiding a health condition. It is the number one reason for claim rejection.
- Buying only the cheapest plan. Low premium can mean a long waiting period or low cover.
- Not reading the policy document. Take 15 minutes to read the key points.
- Waiting too long. Your health does not get better by waiting, but your options can get smaller.
Quick checklist before you buy
- Did I tell the insurer about all my health conditions?
- Do I know the waiting period for my condition?
- Have I checked what is excluded?
- Is the sum insured enough for hospital costs in my city?
- Is the insurer’s claim settlement record good?
Frequently asked questions
1. Will my premium be higher because of my condition?
It can be. Many insurers charge extra for people with a health condition. The amount depends on the disease, your age, and how well it is under control.
2. Can my application be rejected?
Sometimes, yes. This is more likely with serious or uncontrolled conditions. If one insurer says no, another may say yes, so it is fine to compare more than one company.
3. Is a medical test compulsory?
Not always. Younger people and those with a mild condition may get a plan without tests. Older applicants or those with a serious condition are usually asked to do a check-up.
4. What if I get a new disease after buying the plan?
A new illness that starts after your policy begins is not a pre-existing disease. It is covered as per the normal waiting periods in your policy.
5. Will the insurer stop my policy if I make a big claim?
6. Does a pre-existing disease mean a lifetime ban on that condition?
No, in most plans. After the waiting period, the condition is covered. Only some plans may permanently exclude a specific condition, so always read the exclusions.
Final words
Having a pre-existing disease does not mean you cannot get health insurance. With honest information, a little patience, and the right plan, you can protect yourself and your family from big medical bills.
The best time to buy health insurance was yesterday. The next best time is today.
Need help choosing the right plan? Talk to our insurance experts today for a free consultation and quote.
Disclaimer: This article is for general information only. Waiting periods, premiums, and coverage differ from plan to plan. Please read the policy wordings carefully and consult our advisor before buying. Insurance is a subject matter of solicitation.