Pre-Existing Disease And Medical History - What’s The Difference?

Imagine this - you’ve finally decided which health insurance plan to buy and which insurance company to buy from. Now, one of the next things you’ll need to do is fill out the proposal form. This can be rather challenging - especially if you don’t have anyone on your side to help you out.

When you start filling out the proposal form, you’ll come across several fields - first, you’ll have to provide basic, personal details. Then, as you go ahead, you’re asked to provide medical details - that is, details about your medical history and pre-existing diseases. And, you start to wonder - what exactly is a pre-existing disease? How is it different from medical history? And, is it really important to provide details about your medical history and pre-existing diseases to the insurer? If yes, why?

In this article, we answer these and a lot more questions. So, let’s begin!

All you need to know about Pre-Existing Diseases
  • What Is A Pre-Existing Disease?

    The IRDAI defines a pre-existing disease as any condition, ailment, injury, or disease that is diagnosed or treated by a physician 48 months prior to the date of issuance of a health insurance policy.

  • What Is A Medical History?

    Any condition or disease that existed 48 months before you applied for health insurance will be considered as pre-existing. If not, it will be considered a part of your medical history.

    So, basically, medical history includes every little detail of any condition, disease, surgery, or injury you've ever experienced in the past, even the ones you had when you were a child.

    Insurers may request for medical history in the proposal form to evaluate your case for health insurance.

Pre-Existing Disease Vs. Medical History - What’s The Difference?

The main difference between a pre-existing disease and medical history is -

Pre-Existing Disease Medical History
The insurance company will impose a waiting period of 1 to 4 years on pre-existing diseases, depending on the plan you buy. The chances of the insurance company imposing a waiting period on diseases or conditions that are a part of your medical history are minimal.

Let’s understand this better with the help of Jay and Tara’s example.

Jay has been taking oral medications for hypertension for the past two years. He applies for a health insurance plan, where the insurer asks him to make declarations about the first diagnosis of hypertension, medicines taken, duration of treatment, etc. He is also asked to undergo some medical tests. Based on the test results and declarations made by Jay, the insurer applies a waiting period of 2 years for ‘hypertension and related conditions’. So, this means that the insurer will not cover any treatment or hospitalisation costs associated with hypertension or related conditions for 2 years under the policy.

Tara had cancer in her childhood (15 years back), which is now cured. She has not undergone any treatment related to cancer in the last 48 months. She, too, is looking to buy a health insurance plan. In this case, she’ll have to mention ‘cancer’ as part of her medical history. The insurer cannot consider cancer as a pre-existing condition or impose a waiting period because Tara hasn't had any treatment for it in the last 48 months.

exclusion of health insurance plans
Not Covered In Health Insurance
  1. Pre-existing Deceases for a Fixed Term
  2. Cosmetic Surgeries
  3. Injuries caused due to suicide attempts

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How Does The Insurer Use Details About Your Medical History Or Pre-Existing Diseases?

Insurers think twice before offering health insurance to someone with a pre-existing condition or medical history. Wondering why?

Insurers determine your insurability and health insurance premiums on the basis of your medical history including pre-existing diseases. Typically, if you are young and healthy or lead a moderately active lifestyle, and don’t suffer from any ailments or medical conditions, insurers are willing to provide you an annual health insurance cover that is close to 30 to 50 times the premium amount. However, if you suffer from a pre-existing disease or have a medical history, the likelihood of you requiring a hospitalisation rises. So, they will decide whether to offer you the standard deal or not, depending on the medical details you provide.

Hence, it is important that you provide accurate and truthful declarations related to your medical history as well as pre-existing diseases. Based on the declarations you make, the insurance company will assess your health status and evaluate the risk you carry.

Why Should You Make Accurate Declarations To The Insurer?

Insurance is a contract of utmost good faith - so, it is your responsibility to provide complete and honest medical declarations in the proposal form. If you hide or provide incomplete or inaccurate details - and the insurer finds out about it later, they can refuse to pay your claim, or even cancel your policy altogether. In order to avoid these hassles, make sure you make honest and accurate declarations to the insurance company

So, that is all from our side today. We hope you now know what a pre-existing disease and medical history are, how they differ from each other, and why it is important to make complete and accurate declarations in the proposal form.

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