Why is It Important to Disclose Pre-existing Diseases to Your Insurer?
By Okbima 22 May 2023 7

Why is It Important to Disclose Pre-existing Diseases to Your Insurer?

As people age, they are more likely to get illnesses. Nowadays, most people experience diseases like diabetes, hypertension, etc. A medical insurance plan is a protection that shields policyholders from the costs associated with treating such illnesses. In addition, you should be aware that a Pre-Existing Disease (PED) in health insurance is offered with most health insurance policies.

According to this provision, a person with a PED can benefit from coverage for such illnesses after the PED waiting period. According to the specific health care policy and the insurer you purchase coverage from, a PED waiting time may vary from 2 to 4 years.

In this article, we'll talk about health insurance for people with pre-existing conditions and why it's crucial to tell your insurer if you have any illnesses when choosing a health insurance policy.

Pre-existing Conditions in Health Insurance

In the context of health insurance, pre-existing disease in health insurance refers to conditions that an insured person already had when they purchased their coverage. Although PED is typically covered by healthcare insurance, the insured must first wait until the waiting period is finished before getting such coverage. 

Because of this, after the waiting time, those with health insurance can submit claims for the costs of PED therapy. Generally speaking, the PED waiting time lasts between two and four years. So, starting on Day 1 of the policy's start date, a policyholder cannot get coverage for PED conditions. Instead, customers must wait a long time to use the service.

Even when an insured submits a claim for PED conditions before the end of the waiting time, the insurer will reject the claim, and no compensation will be granted until the waiting time for such conditions has passed. On the other hand, some health insurance policies offer coverage for pre-existing diseases in health insurance right away as the policy begins.

Also, pre-existing condition premiums are increased by health insurance companies for those who purchase health policies. Because insured with PED are more prone to file claims for illnesses from which they currently suffer. As a result, the insurance views them as a risk, so the insurer assesses an additional fee.

It is one one the reasons why so many people attempt to conceal their PED at the time when they are purchasing a plan through their insurer. However, this is not a good idea since the policyholder might face legal repercussions for failing to disclose their medical conditions when purchasing coverage.

Why It's So Essential to Tell Insurance Companies About Pre-Existing Conditions?

Most insurance applicants try to conceal pre-existing conditions from insurers to avoid paying a higher premium for health coverage. However, policyholders should avoid making the mistake of failing to disclose the PED when obtaining a policy.

It is crucial to publish the list of pre-existing conditions at the moment a policy is purchased

? In reality, health insurance providers for diverse policyholders assess rates for specific health plans based on several variables. Age, physical condition, and any illnesses that the person may already have are a few of these considerations. When purchasing a policy, the policyholder must complete the form by entering all this information.

? The insurer accepts the information provided in the form as being correct. However, the policy's premium and other factors are also decided upon based on the same. As a result, a policyholder must be honest when disclosing any pre-existing disease in health insurance to determine the appropriate premium and other factors. 

? False information is now seen as a breach of trust, and the individual who provides it will likely face punishment from the insurer. Moreover, if the presence of PED is discovered later during the coverage, the insurer may declare the health plan worthless and deny the claim for a trust violation.

? Moreover, certain insurers may file a lawsuit against the insured on fraud-related grounds if they believe that fraudulent information was provided. It is preferable to declare any PED you may have when you acquire coverage to prevent such complications.

Why Is A Pre-Existing Sickness Different From A Medical History?

A pre-existing disease in health insurance and medical background are two distinct things. Any illness an individual has been dealing with for 48 months before registering for health insurance is considered a PED. On the other hand, a person's medical record may include any ailments they may have had since childhood.

What Factors Determine Whether A Person Qualifies For Health Insurance If They Have A Pre-Existing Condition?

Prevalent conditions, including hypertension, diabetes, hypo or hyperthyroidism, and cholesterol, are typically considered pre-existing conditions in health insurance. However, it's crucial to realize that pre-existing diseases in health insurance do not include typical illnesses like fever, influenza, cough, colds, etc., which can't worsen over time.

Does A Health Insurance Policy's Coverage For Pre-Existing Conditions Completely Exclude Them?

When learning what constitutes a pre-existing condition for the purposes of health insurance, a typical query is whether the policy covers all claims relating to the condition. "NO" is the response to it. Health insurance providers pay claims for certain conditions once the waiting time has passed. 

When waiting, the insured person cannot submit claims for pre-existing disease in health insurance. It depends on the supplier and might range between two and four years. Choosing a shorter waiting period policy is advised if you anticipate needing to file a claim for this condition soon.

Aspects Of Pre-Existing Disorders Must Be Taken Into Consideration

Other factors to take into account include

? Finding an Illness that Was Already Present

To make it simpler for the potential policyholder to examine and determine whether or not he has any pre-existing ailments, he must first be provided with an idea of what pre-existing diseases entail. Choosing a greater insured amount when purchasing health insurance to address pre-existing diseases in health insurance is advised.

? Whole Medical History Disclosed

The insurance provider could additionally inquire about any further health issues you may have; however, some just want to know about your medical history over the past 2 to 5 years, in accordance with the terms and conditions of the policy and the supplier. The policyholder's best interests depend on him being entirely and truthfully honest with all the information.

? Checkup Before the Insurance

You may need a medical examination to identify any pre-existing disorders and assess your current state of health.

? Considering the Waiting Period While Selecting an Insurance

Getting insurance with a reduced waiting time is wise if you anticipate the situation worsening soon. Based on the individual's medical circumstances, it's a personal assessment.

? Clause of Premium Loading

It implies a higher-than-average premium fee. The insurance provider will charge a higher premium since it takes a chance by providing coverage for an existing condition. Only when you purchase the coverage is this premium loading effective. If the insurance is continuously renewed without a gap in coverage, it will not be charged again.

? Waiting Time

Before your insurance coverage covers your pre-existing disease in health insurance, you must wait for this time. However, the waiting duration is not constant. The condition, the level of coverage, and the insurance provider providing the policy all have a role. A hernia, for instance, would have a four-year waiting period if it was determined to be a pre-existing condition. Hence, if there is continuous coverage, the insurance will cover a hernia four years after the date of purchase.

? Complete Exclusion

Nonetheless, the pre-existing condition may be excluded from the insurance company's offer of coverage. You must acknowledge that the pre-existing condition is a policy exclusion that will never be lifted. In this manner, depending on the conditions and circumstances of the insurance, you may not be covered for an illness or disease but will be for other health-related eventualities.


In conclusion, although many consumers worry that their plans will be denied or their premiums will become unaffordably expensive if they divulge pre-existing medical issues, this is not the case. To the insurance company, you must also make sure to note this. 

This is so that the proposal may be determined by weighing the risks, and it can be said that breaking the agreement would be to withhold crucial information like the pre-existing disease in health insurance. This can result in allegations that you made about how these conditions failed to help you in situations of need being rejected. 

But, after waiting, you may be eligible for reimbursement for these expenses by telling your insurance company. Now more than ever, purchasing health insurance is simple, which is essential. With okbima, it is possible to compare health insurance providers and the plans they provide, look at the list of cashless hospitals, calculate rates, and even renew current policies online.

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