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Sunday, August 09, 2020

How do pre-existing diseases affect your health insurance premium?

Health matters and so does a health insurance...

Updated: July 21, 2020 8:54:03 pm
Image credits: Bajaj Allianz General Insurance

Health insurance has been in the limelight ever since the outbreak of Covid-19 in India. However, certainly not for the wrong reasons. It is just that the importance of having a health cover has increased much more than earlier. Living without a health insurance policy is like sharing your banking credentials with the hospital. We all need a health cover, but more vulnerable to the virus are those who may have some existing adverse health conditions.

This has been well established by medical science now. A recent research report by the London School of Hygiene & Tropical Medicine, published[1] in The Lancet Global Health, has found out a direct relationship between the existing health conditions and the risk of contracting Coronavirus. The report estimates that 1·7 billion people globally have at least one underlying condition such as chronic kidney disease, diabetes, cardiovascular disease, and chronic respiratory disease that puts them at increased risk of severe COVID-19, if infected.

It is, therefore, important to keep guard not only against the spread of the virus but also take appropriate steps to keep your finances safe. A hospitalisation may set back anyone with a few lakhs, if not more, due to any pre-existing disease or any morbidity condition, including Covid-19. 

The solution lies in having a health insurance plan which ensures the hospital bills get paid by the insurer at the time of hospitalisation. All this by paying a small premium for a large sum insured for health coverage.

But, remember your pre-existing diseases have an impact on the premium that you pay. Here’s how. 

Your health matters too

Maintaining good health saves money! Your lifestyle and health parameters matter a lot when it comes to paying the premium. Someone in good health has to pay the regular premium, but those with health risks are required to pay a slightly higher premium. The insurer makes the individual undergo certain medical tests, including looking at the person’s BMI – Body mass index.  

Loading of premium

An adverse BMI or medical reports showing signs of health-related ailments may hike your premium. The insurer may ask you to pay ‘extra premium’, called ‘loading’, before they provide you with insurance coverage. 

Why extra premium

As a policyholder, one expects the insurer to honour claims at the time of hospitalisation. To ensure this happens seamlessly, insurers take various steps to ensure ‘unhealthy lives’ do not gain at the cost of ‘healthy lives’. Loading helps to maintain the balance so that the claim settlement process is smooth for all policyholders. 

What if one has pre-existing ailments

But, what if someone is already suffering from certain ailments at the time of buying a health insurance policy? Nothing to worry! One won’t be denied insurance unless the medical underwriting guidelines of an insurer disallows them as permanent exclusions.

Waiting period for pre-existing ailments

It’s not that all pre-existing ailments are excluded by the insurers. To ensure that even existing health ailments get covered, insurers keep a waiting period before they are addressed. Insurers have specific waiting periods for certain specific ailments or treatments while in general there is a waiting period of 48 months for all pre-existing ailments. Some plans may have a lesser waiting period of 36 months. 

What makes up a pre-existing disease

One of the most crucial links in the claim settlement of health insurance policy is the existence of any pre-existing disease. To keep it transparent and standardised, the insurance regulator has defined it as – “Any condition, ailment or injury or related condition(s) for which you had signs or symptoms, and / or were diagnosed, and / or received medical advice / treatment within 48 months to prior to the first policy issued by the insurer.”

At the buying stage many buyers make a common mistake. Some of them hide or fail to disclose them in the health insurance application form, thinking they anyhow won’t be covered till the end of the waiting period. But, sitting pretty and not disclosing the existence of a pre-existing disease may impact any claim in the future. 

Disclosure

Therefore, making full disclosure of medical history, pre-existing ailments and even on-going medication is important while applying for a health cover offline or buying online. One should never hide any pre-existing ailment or even symptoms from the insurer as it may impact the claim settlement. An honest declaration will go a long way in meeting hospital costs during hospitalisation. 

Read policy document carefully

Once you pay up the ‘extra premium’ based on your health risks and the insurer has accepted your application, it’s time to make sure about the inclusions and the conditions, if any, set by the insurer. The policy document is the legal contract between you and the insurer and is sent to you after the policy gets issued. Do go through in detail to know the coverage conditions, inclusions and exclusions in the policy. 

What to do

Make an informed buying decision while paying premium for the health insurance plan. Individual Health Insurance and Family Health Insurance plan of Bajaj Allianz General Insurance are two such plans that you should consider opting for. If you are looking for a health plan with unlimited coverage, Health Infinity Plan is the one tailor-made for you. And, do not forget to top-up with the Bajaj Allianz General Insurance Critical Illness Insurance plan for complete coverage.

The premium is impacted by your pre-existing health conditions, but do not let the claim get impacted by not disclosing them. It is often suggested to pay the extra premium and get the coverage for one’s existing ailments or adverse health conditions to ensure peace of mind. Buying the right plan from the bouquet of health insurance products of Bajaj Allianz General Insurance is just a click-away.

Source:
[1] `https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30264-3/fulltext`

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