What's a TPA (Third Party Administrator) In Health Insurance | Pazcare
TPA in health insurance, Advantages of TPA, Role of TPA, Top TPA companies
September 21, 2022
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Yes, generally group health insurance covers pre-existing diseases. It is one of the most significant advantages you don't get with a retail insurance policy
But before we jump into the topic of group health insurance and pre-existing diseases cover, let us understand what is a pre-existing disease.
In simple words, 48 months prior to the effective date of the policy issued by the insurer, if you suffer from any disease or ailment that requires medical treatment then, it is considered a pre-existing disease. It can be diseases like cancer, asthma, or conditions like blood pressure, diabetes, etc.
A retail health insurance policy does not cover pre-existing diseases immediately after purchasing a policy. Your insurer conducts a pre-medical screening to know if you suffer from any of the pre-existing conditions mentioned in your policy copy.
The retail health insurance policy has a waiting period. During this period, if you have any medical expenses generated due to any of the pre-existing conditions, your health insurance does not cover those expenses.
For instance, let us assume Riya has an individual health insurance plan that she purchased a year ago. She suffers from asthma and is admitted to the hospital for the same. According to the IRDAI an insurance provider can have a specified duration of the waiting period for a pre-existing condition. On average, it can be 2 to 4 years.
Now after the hospitalization and treatment, Riya has generated a medical bill of Rs. 90,000. Now, she cannot claim her medical expenses with her active health insurance policy until she completes the waiting period mentioned in her policy copy.
Different insurers might have different sets of pre-existing conditions. Here is the common list of pre-existing conditions.
Now let us answer the question.
Pre-existing diseases are covered in a group health insurance plan. Most organizations offer group health insurance policy that cover pre-existing conditions. These pre existing diseases are covered from day 1 of the policy. Unlike a retail policy there is no waiting period. In case, the pre-existing diseases are not covered in the policy, the employer can opt for a pre-existing diseases coverage add-on to the policy. In this case, there will be an additional group health insurance premium paid for this add-on.
All the details of the group health insurance policy coverage will be mentioned in the master policy copy. This will be issued in the name of the employer of the organization.
Unlike a retail health insurance policy, the group insurance policy for employees does not require any pre medical screening. This is one of the major advantage of a group health insurance plan over an individual health insurance plan.