A pre-existing disease refers to any illness, or medical condition that a person already has before buying a health insurance policy. Such conditions are usually covered only after a waiting period, as mentioned in the policy terms.
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.
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.
Some common examples of pre-existing diseases include:
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.
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:
Pre-existing diseases are crucial in determining:
Being transparent about any pre-existing conditions during policy purchase or enrollment helps avoid claim rejections or policy cancellations.
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.
When filling out your health insurance proposal form or joining a group policy, you must:
Non-disclosure of pre-existing diseases can lead to:
A pre-existing disease (PED) is any medical condition, illness, or injury that was diagnosed or treated by a doctor within 48 months (4 years) before purchasing a health insurance policy. Common examples include diabetes, hypertension, asthma, thyroid, and heart disease.
Any chronic or ongoing condition that requires medical attention or medication before the policy start date is considered a pre-existing condition.
It’s the timeframe (usually 1–4 years) after buying the policy during which treatment for pre-existing conditions is not covered.
Yes, many modern policies now offer day-one coverage for pre-existing conditions, especially when customised through platforms like Pazcare.
Yes, diabetes is one of the most common pre-existing diseases.
HRs also look for
Plan employee benefits with our experts
That fit your budget and expectations
Best pricing for you.
Best claim support for your team.
AICPA SOC 2
.svg)
ISO 27001
.svg)
ISNP
App for employees
.webp)