Pre-existing diseases or PED, in the insurance parlance, are usually not covered by the health insurer for a defined period when you sign up for a policy. That period is generally around four years for most policies, including the most basic plans, across insurers. Thus, for the first four years, the policyholder will be under-covered for any health issue that the attending doctor ascertains to be caused by or complicated by an already existing condition. These could be the common chronic conditions such as diabetes, blood pressure, cardiovascular diseases or specific diseases such as cancer, tuberculosis, and thyroid conditions. Ironically, these could be the conditions that instigated the purchase of a health insurance plan in the first place. Is there a way out ? Fortunately, yes.

With the health insurance marketplace getting crowded and competitive, one can always find a workaround, for the dreaded PED waiting times included. We present these different options across policies and across the two sums assured of ₹5 lakh and the ₹1-crore plan, with the latter getting higher traction nowadays.

Working around wait times

The basic plans from National Insurance, Oriental Insurance or even SBI General insurance have the standard four-year PED waiting condition. The standardised policy ‘Arogya Sanjeevani’ guided by IRDAI also insists on  a four-year waiting period for PED conditions. The waiting is same even in the private space for the most basic variants of health insurance policies. There are few ways to work around the wait time.

Using a rider: The first way is to opt for a rider which is bought additionally over the base policy. Care Health Insurance and Star’s Comprehensive Health insurance offer a rider which reduces the waiting period from four years to two years and one year respectively. The rider costs 13 per cent more for Care and 20 per cent more for Star, than their respective base price. Star’s Young Star Silver plan offers one-year PED waiting in the base policy itself, but the policy can be signed up by 18-40 year olds only. Star’s rider and Young star plan is available on ₹1-crore sum assured policy as well with similar PED waiting times.

Opting for waiver on specific diseases: Aditya Birla’s chronic management plans lower waiting periods for specific diseases alone for higher premiums. While the basic plan calls for a four-year PED waiting period, their enhanced plan (at 20 per cent more premium) reduces it to three years. This is available even for their ₹1-crore sum assured plans. In such plans with chronic management option, the policyholder gets an automatic upgrade to chronic management plan on diagnosis of specific conditions — asthma, high BP, high Cholesterol and Diabetes. OPD cover for diagnostics and consultation becomes available from Day 1. The specific disease gets covered after 30 days of diagnosis. For instance, on being diagnosed with diabetes and upgrading to diabetes plan, the policyholder will be covered for related ailments after 30 days compared to the normal three-year waiting period for other diseases. However, these disease specific plans can be purchased initially and are available for ₹1-crore sum assured as well.

How to select
The policyholder, while scouting for health insurance, should consider a lower PED waiting as a key component of filtering

Settling with lower wait time by using high sum assured: Some policies offer a lower PED waiting time in their ₹1-crore sum assured policies. Navi Health insurance, for instance, has the higher sum assured which offers a three-year PED waiting time. This is similar to Edelweiss’ health insurance plan, but Edelweiss offers a two-year PED waiting period. Manipal Cigna has a lower sum assured option, but two-year PED waiting is offered in ₹1-crore policy compared to three years waiting in ₹5-lakh policy.

Looking up for polices with less than the usual four-year wait time: Within the base policy itself and with no other conditions attached, Tata AIG Medicare and Reliance General Insurance (Silver and Gold) plans offer a two-year PED waiting times. Many other insurers, including Royal Sundaram, Chola MS and Future Generali, offer three-year PED waiting. Future Generali actually starts from two-year PED waiting period, but offers only 50 per cent of sum assured in the third year for PEDs. Bajaj Allianz offers a three-year PED waiting on its ₹1-crore policy and so does Reliance General for its variant policies named More Time, More Coverage or More Global.

Unless one is entering a health insurance contract at a young age and no history of chronic or other conditions in family history, one should always look to lower the PED waiting period. The policyholder, while scouting for health insurance, should consider a lower PED waiting as a key component of filtering, given the wide range of options available.

Related Topics
comment COMMENT NOW