I Have a Pre-Existing Disease — What Happens?

5 min read · Free guide

A pre-existing disease (PED) is any condition, ailment, injury, or related condition for which you had signs, symptoms, or received medical treatment in the 48 months before buying the policy. Common examples: diabetes, hypertension, asthma, thyroid disorders.

The golden rule: Always disclose honestly

Never hide a pre-existing condition. This is the #1 cause of claim rejection. IRDAI regulations and court rulings consistently uphold rejection of claims where the policyholder suppressed material information. The short-term premium savings are never worth the risk.

What happens after you disclose?

The insurer can do one of the following:

  1. Accept with standard premium — If the condition is minor and well-controlled
  2. Accept with loading — Higher premium due to higher risk
  3. Accept with exclusion — Cover everything except that specific condition
  4. Decline — Rare, usually only for very serious uncontrolled conditions

PED waiting period explained

Standard waiting periodWhat it means
2–4 years (industry standard)PED is not covered for this period; all other conditions ARE covered
1 year (some plans)Can be achieved with a PED waiver rider (costs extra)
0 days (group policies)Employer group insurance often has no PED waiting period

After the waiting period

Once the PED waiting period is over, your condition is fully covered like any other illness — subject to the policy terms and sum insured.

Portability saves your waiting period credit

If you switch insurers, your accumulated waiting period credit transfers with you (as per IRDAI portability rules). 2 years served with insurer A counts as 2 years when porting to insurer B.

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