Pre existing disease

This glossary will help you understand what pre-existing diseases (PEDs) are, how they impact your health insurance coverage, and why group health insurance offers better protection.

What is a pre-existing disease?

A pre-existing disease (PED) refers to any illness, injury, or medical condition that an individual has been diagnosed with or received treatment for before buying a health insurance policy.

In simple terms, if you already have a health condition like diabetes or hypertension before your policy starts, it’s considered a pre-existing disease.

Common pre-existing diseases list

Some common examples of pre-existing diseases include:

• Diabetes
• Hypertension (high blood pressure)
• Asthma
• Thyroid disorders
• Heart disease
• Arthritis
• Chronic Obstructive Pulmonary Disease (COPD)
• Kidney disorders

Benefits of coverage for pre-existing diseases

Getting coverage for pre-existing diseases ensures you’re protected against hospitalization or treatment expenses related to your ongoing medical condition.

This is especially beneficial for employees with lifestyle-related illnesses, as healthcare costs for such conditions can be high.

Pre-existing disease waiting period

In most individual health insurance plans, there is a waiting period of 2 to 4 years before you can claim expenses related to pre-existing conditions.
During this period, the insurer won’t cover hospitalization or treatment arising from PEDs.

However, group health insurance (GHI) offered by employers often provides:

• Reduced waiting periods
• Zero waiting period coverage, meaning employees get immediate protection for existing illnesses.

Why it matters in health insurance

Pre-existing diseases are crucial in determining:

• The premium amount (higher risk may mean a higher premium),
• The waiting period
• Claim approvals.

Being transparent about any pre-existing conditions during policy purchase or enrollment helps avoid claim rejections or policy cancellations.

Pre-existing disease covered from day 1 – Is it possible?

Yes under corporate or group health insurance plans, pre-existing diseases are often covered from Day 1.

For example: If an employee already diagnosed with diabetes joins a company that provides group health insurance, they can receive immediate coverage for diabetes-related hospitalizations.
This is a major advantage over individual health insurance plans, where coverage for such conditions usually begins only after the waiting period ends.

How to declare pre-existing diseases?

When filling out your health insurance proposal form or joining a group policy, you must:

• Disclose all known medical conditions truthfully.
• Provide relevant medical reports if requested by the insurer.

Non-disclosure of pre-existing diseases can lead to:

• Claim rejection, or
• Policy cancellation later.