July 22, 2021

One of my relatives bought a health insurance policy for his father. At the time of filing the proposal form, he marked absence of any pre-existing disease, as his father did not have any illness or condition at the time, when he bought the policy. After a period of 2 years of buying the policy, when his father got hospitalized due to an illness, the claim was rejected and the reason stated was ‘non-declaration of pre-existing illness’.

Although, my friend did not lie to the company, as his father did not have any illness at the time of purchasing the policy. He is confused, what could be the reason for rejection. Whether the insurance company cheated him? Actually, it was neither my friend who was lying, nor it was the insurance company who cheated. The reason behind the rejection is the ‘pre-existing illness’, which he had not understood correctly.

In the last few years, the majority of the claims is rejected on the ground of pre-existing illness. This impression may make you lose faith in health insurance. It’s not that health insurance does not cover the pre-existing illness. The only thing is that you need to understand the ins & outs of pre-existing condition, before buying a health insurance policy.

What is a Pre-Existing Condition?

It refers to a medical condition/disease/illness that existed, prior to buying a health insurance policy. It means the insurance company would not pay any claims for an illness, ailment, injury or related condition, for which you had symptoms, was diagnosed, and/or received medical advice/treatment, before commencement of the policy.

Although, its definition seems quite simple, but people often misinterpret it that lead to rejection of claims.

If you have diabetes or hypertension, then it’s not that your claim will get rejected only for diabetes. There are various other illnesses that may cause due to diabetes and one of them is kidney failure, paralysis, stroke, and heart disease. So, these diseases will also not be covered as stated under the policy.

Waiting Period of Pre-Existing Condition

Insurance companies do not cover pre-existing conditions during the 48 months of health coverage under the first policy. Pre-existing conditions are covered only after completion of 48 months of continuous health coverage. However, this waiting period varies from 12 to 48 months, as specified under the policy schedule.

The treatment for such ailments are covered only after completion of the waiting period as applicable. Health insurance requires you to pay premiums on time and you will get the medical cover, even for pre-existing conditions. The only aspect to consider here is, you have to wait for completion of the waiting period.

Disclose your Pre-Existing Condition

While filling the proposal form for buying a health insurance, it is recommended to disclose your pre-existing condition. In case, you hide this medical condition, the insurance company makes several checks before settling the claim and one of which is pre-existing ailment and, if it is found that you were suffering from a pre-existing ailment and did not reveal it in the proposal form, your claim will lead to rejection.

When disclosing the pre-existing illness/ailment, you will be charged with the higher premium, but the company will give you the cover and they don’t have any reason to deny the settlement of your claims.

Don’t forget to Read this Articles: Health Insurance Policies cover Pre-Existing Diseases


A health insurance policy provides cover for unforeseen medical emergencies, even if you are having pre-existing ailments. Prior to buying a policy, it is advisable to read the terms related to pre-existing illness such as which illness or illnesses are covered, its waiting period and exclusions applicable. It will help you choose a health insurance policy that covers your pre-existing condition and caters to your healthcare needs.

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