Health Insurance Queries: Pre-existing Conditions and New Illnesses Explained

ET Wealth Reader's Query: My wife and I have had a floater health insurance policy for over four years. We declared diabetes as a pre-existing condition. Now we have high cholesterol and mild fatty liver. Will my insurance cover pre-existing and new illnesses?

Listen to this article in summarized format

These are a set of queries raised by ET Wealth readers, which have been answered by our panel of experts.

My wife and I have had a floater health insurance policy for over four years. We declared diabetes as a pre-existing condition. Now we have high cholesterol and mild fatty liver. Will my insurance cover pre-existing and new illnesses?

Sarbvir Singh Joint Group CEO, PB Fintech: For the diabetes you declared at the time of purchase, health insurance policies apply a waiting period, now capped at 36 months under IRDAI guidelines. Since you’ve held your policy for over four years with continuous renewals, this condition should now be covered as per your policy terms. For cholesterol and mild fatty liver developed later, these are not treated as pre-existing. Treatments related to such diseases are covered in the policy after the initial waiting period of 30 days.

Health insurance rewards continuity. Customers who plan early, disclose honestly, and stay invested in their policy over the long term put themselves in the best possible position when they actually need to claim. Taking a cover early and maintaining it consistently reflects strong financial discipline and foresight. Importantly, under IRDAI regulations, once you have maintained your policy continuously for five years, it becomes non-contestable, except in cases of proven fraud.

ALSO READ | Can me and my wife claim LTCG tax exemption on gains from residential property sold in 2025?

How will my insurance provider treat my pre-existing disease that’s clearly marked as such (‘PED’) in the document?

Sarbvir Singh Joint Group CEO, PB Fintech: If your insurer has marked a condition as a pre-existing disease in the policy document, it simply means the ailment existed before the policy was issued and will be covered after a defined waiting period. Under the revised Insurance Regulatory and Development Authority of India (Irdai) norms, a condition is generally treated as pre-existing if it was diagnosed, treated or medically advised within 36 months prior to policy issuance. The positive shift is that regulations have become more consumer-friendly over time.

The standard waiting period for PEDs has now been reduced from four to three years. During this period, claims related to that specific condition may not be admissible, but the policy continues to provide protection against un related illnesses and medical emergencies from day one, subject to policy terms. The market has also evolved for customers with existing health conditions. Several insurers offer far more modular plans, including options with Day 1 coverage for conditions such as diabetes, hypertension and asthma, at relatively reasonable premiums. This gives customers the flexibility to choose plans with immediate coverage benefits, depending on their healthcare needs and financial comfort. You could explore the options with your insurer adviser to identify what’s best for you.

Our panel of experts will answer questions related to any aspect of personal finance. If you have a query, mail it to us right away. Email ID: [email protected]

(Disclaimer: The opinions expressed in this column are that of the writer. The facts and opinions expressed here do not reflect the views of www.economictimes.com.)

(Join our ETWealth WhatsApp channel for all the latest updates)