Best Health Insurance for Pre-Existing Conditions in India
Finding the right health insurance can be challenging, especially when pre-existing conditions come into play. In India, the number of pre-existing health conditions is staggering. Approximately 32% of customers purchased health insurance while having a pre-existing condition. This was a jump from 17% in the year 2022. (Source: Mint)
Given that, 30% more health claims have been made in the past three years, among which heart disease accounts for 25% to 30% of these claims. (Source: Business Standard) Hence, securing the right plan is more important than ever. This guide breaks down the best health insurance options for people with pre-existing conditions.
Top 6 Health Insurance For Pre-Existing Conditions
| Features | HDFC Ergo Optima Restore Policy | Care Supreme | Care Advantage | ManipalCigna Prime Active | Tata AIG Medicare | ICICI Lombard Complete Health Insurance |
|---|---|---|---|---|---|---|
| Type of Pre-existing Conditions (PED) Covered | All declared and accepted Pre-Existing conditions / diseases will be covered | All declared and accepted Pre-Existing conditions / diseases will be covered; offers faster PED coverage (12–24 months). | All declared and accepted Pre-Existing conditions / diseases will be covered, subjected to 48 months waiting period | All declared and accepted Pre-Existing conditions / diseases will be covered | All declared & accepted (after underwriting). | All declared and accepted Pre-Existing conditions / diseases will be covered |
| Waiting Period for Pre-existing Conditions | 36 months | 36 months | 48 months | 24 months | 24 months | 48 months |
| Instant Cover |
No (Accidents covered from day one; new illnesses have 30-day wait) |
For Hypertension or Diabetes or Hyperlipidemia or Asthma post initial wait period of 30 days. | No | Yes, Covers you from 91st day for pre-existing conditions such as Diabetes, Hypertension, Asthma, Dyslipidemia & Obesity | No | No |
| Coverage for Complications | Yes, once PED waiting is served. Includes complications arising from declared PED. | Yes, complications covered after their shorter or standard PED waiting period. | Yes, covers complications after 48-month PED wait. | Yes, once 24-month wait is over. | Yes, post 36-month PED wait | Yes, post the specified PED wait |
| Cashless Facility | Yes, ~16,000+ network hospitals | Yes, ~16,500 network hospitals | Yes, ~16,500 network hospitals | Yes, ~6,500 network hospitals | Yes, ~7,200 network hospitals | Yes, ~6,700 network hospitals |
| Pre/Post Hospitalization |
60 days Pre 180 days Post |
60 days Pre 90 days Post |
30 days Pre 60 days Post |
60 days Pre 90 days Post |
30 days Pre 60 days Post |
30 days Pre 60 days Post |
|
Normal Waiting Period (for new illnesses) |
30 days | 30 days | 30 days | 30 days | 30 days | 30 days |
|
Premium Range (Approx. Annual) |
~₹7k–₹10k (Individual, 30 yrs, SI ~₹5–₹10L) |
~₹8k–₹12k (Individual, 30 yrs, SI ~₹5–₹10L) |
~₹7k–₹10k (Individual, 30 yrs, SI ~₹5–₹10L) |
~₹8k–₹14k (Individual, 30 yrs, SI ~₹5–₹10L) |
~₹7k–₹15k (Individual, 30 yrs, SI ~₹5–₹10L) |
~₹8k–₹12k (Individual, 30 yrs, SI ~₹5–₹10L) |
| Coverage for OPD / Medication |
No OPD in base plan (optional add-on possible) |
Yes, OPD coverage included in certain Supreme variants | No OPD in base variant | Yes, OPD coverage with “Prime Active” |
No OPD in base (rider may be available) |
Optional OPD via add-on rider |
|
Claim Settlement % (Overall) |
~93–95% | ~93–95% | ~93–95% | ~90–92% | ~90–92% | ~90–93% |
| Unique Benefits |
- Restore Benefit once SI is exhausted - 180 days post-hospitalization - High claim ratio - Family discount of 10% is applicable if two or more family members are covered under Optima Restore Individual Sum Insured plan. - An additional 7.5% discount is odered on the premium if you choose a 2 year policy. |
- For Hypertension or Diabetes or Hyperlipidemia or Asthma post initial wait period of 30 days. - OPD coverage - 30% discount on renewal - No sub-limits on modern or conventional treatments |
- High coverage options (up to ₹1 Cr) - “Care Advantage” with large hospital network |
- Covers you from 91st day for pre-existing conditions such as Diabetes, Hypertension, Asthma, Dyslipidemia & Obesity - Waives off your next 1 year renewal premium in case of Accidental Death or diagnosis of any of the listed Critical Illnesses - Standing Instruction Discount 3% on renewal - Long Terrn Discount -- 2 years 7.5% & 3 years 10% - Weliness Discount of up to -- 15% with Condition Management Program |
- Optional global coverage - Range of sum insured options |
- “Reset” or “Reload” SI feature - Multiple digital add-ons |
| Is Portability Available | Yes (IRDAI norms) | Yes (IRDAI norms) | Yes (IRDAI norms) | Yes (IRDAI norms) | Yes (IRDAI norms) | Yes (IRDAI norms) |
| Sum Insured (in ₹) | ₹3L – ₹50L | ₹5L – ₹1Cr | ₹10L – ₹1Cr (commonly) | ₹3L – ₹50L | ₹3L – ₹50L (depending on variant) | ₹2L – ₹50L (variants) |
| Entry Age | 18–65 years (adult), children as dependents | 18–65 years (adult), children as dependents | 18–65 years (adult), children as dependents | 18–65 years (adult), children as dependents | 18–65 years (adult), children as dependents | 18–65 years (adult), children as dependents |
|
Policy Type (Individual / Family Floater) |
Both | Both | Both | Both | Both | Both |
| Policy Tenure | 1 / 2 / 3 years (renewable) | 1 / 2 / 3 years (renewable) | 1 / 2 / 3 years (renewable) | 1 / 2 / 3 years (renewable) | 1 / 2 / 3 years (renewable) | 1 / 2 / 3 years (renewable) |
| Refill / Restoration Benefit |
Yes – “Restore” (for non-related claims in same year) |
Yes – “Unlimited Auto Recharge” in some Supreme variants | Yes – “Automatic Recharge” | Yes – can replenish SI for different ailments | Yes – “Restoration” of SI | Yes – “Reset/Reload” of SI |
| No Claim Bonus | Yes – up to 50–100% for claim-free years | Yes – can reach 150% in some variants | Yes – 50–150% progression | Yes – cumulative increase each year of no claims | Yes – typically 10–50% increment | Yes – incremental SI each claim-free renewal |
*Please read the disclaimer at the end of this page before purchasing this policy.*
Our Top 2 Picks for Pre-existing Conditions Health Insurance
Among the six best insurance for pre-existing health conditions in India, we have come up with our top two picks, after analysing their features and comparing the benefits with other available plans:
Care Supreme
Care Supreme is a comprehensive health insurance plan offering up to 7 times the base sum insured through cumulative bonuses, unlimited automatic recharge for related and unrelated illnesses, and up to 30% renewal discounts via an active wellness program.
Why It Stands Out
Instant Coverage for Pre-existing Conditions: There is instant coverage for hypertension, diabetes, hyperlipidemia, and asthma post initial wait period of 30 days.
OPD Coverage: Select variants include outpatient department (OPD) expenses, reducing out-of-pocket costs for consultations and minor procedures.
High Network Access: Taps into Care Insurance’s extensive hospital network (16,500+ hospitals) for cashless services.
Potential Limitations
PED Wait: The waiting period is relatively long at 36 months.
Sub-limits & Conditions: Certain advanced treatments or room rent choices may have sub-limits; always review the fine print in the policy schedule.
Premium Impact: Faster PED coverage and OPD benefits can push premiums higher compared to a standard policy without these features.
ManipalCigna Prime Active
ManipalCigna Prime Active is a comprehensive individual health insurance plan that covers pre-existing conditions like diabetes, hypertension, and obesity. It offers tailored benefits, including day-one coverage for diabetes-related hospitalisation, wellness rewards, and a premium waiver for maintaining good health.
Why It Stands Out
Instant Coverage: Provides coverage from the 91st day for pre-existing conditions such as diabetes, hypertension, asthma, dyslipidemia, and obesity.
Comprehensive OPD Coverage: Notably includes OPD expenses from day one, covering consultations, diagnostic tests, and even pharmacy bills in certain variants.
Shorter PED Waiting: A 24-month waiting period for pre-existing conditions is fairly competitive, making it valuable for those who need coverage sooner.
Enhanced Wellness Benefits: Emphasises preventive care, health check-ups, and day-one coverage for some wellness features, aligning with a proactive health management approach.
Potential Limitations
Moderate Hospital Network: While ManipalCigna’s hospital network is sizeable (6,500+), it may be smaller than some competitors (e.g., those with 10,000+ hospitals).
Premium Costs: The inclusion of OPD coverage and wellness perks can make the policy pricier compared to more basic plans.
What is a Pre-Existing Disease?
Pre-existing diseases, or PEDs for short, are major health conditions that individuals are already treating before buying a health policy. Ideally, it is an illness you were diagnosed with at least 48 months before buying your health insurance policy. Common examples of pre-existing health conditions include diabetes, asthma, hypertension, heart disease, and thyroid.
Is it Necessary to Disclose Pre-Existing Health Condition Before Buying Insurance?
Yes, you need to disclose any pre-existing condition to your insurance provider before purchasing a policy. This is to ensure that you do not face any issues when making a claim. While PEDs come with a waiting time for making claims, it is better to wait it out than get your claim rejected.
Here are some reasons why you should disclose your pre-existing health conditions before buying insurance:
1
Reduces the Risk of Policy Cancellation
Insurers can cancel your policy if they discover an undisclosed pre-existing health condition. To prevent this, it is always best to be transparent about your health condition.
2
Gives Insurer Accurate Risk Assessment
Insurance companies evaluate risk before offering you a policy. When they have a clear picture of your health, they can provide appropriate coverage and pricing.
3
Makes the Settlement Process Smoother
No one wants to deal with claim delays, endless paperwork, or outright rejection in a medical emergency. If your insurer already knows about your condition, they can process your claims smoothly without questioning your medical history.
4
Provides Tailored Coverage
Being honest about your health condition allows insurers to offer a plan that actually suits your needs. Some insurers even provide specialised plans for conditions like diabetes, hypertension, or heart disease, ensuring better benefits and fewer surprises later.
5
Builds Trust
Being transparent builds trust between you and your insurer. When you disclose everything honestly, they are more likely to support you when you file a claim. Plus, you get peace of mind knowing you are covered fairly and would not have to battle fine print later.
Do Pre-Existing Health Conditions Affect Your Health Insurance Plans?
Yes, the existence of any long-term health condition before taking a policy may affect your health insurance plan, making pre-existing health conditions a hurdle in India. For insurers, they pose a financial risk since individuals with these conditions are more likely to need frequent medical care, leading to higher claims. Chronic illnesses like diabetes and heart disease require regular doctor visits, long-term medication, and sometimes hospitalisations, making them expensive to cover.
To balance this risk, insurance companies often raise premiums or impose waiting periods, which can make it harder for people with pre-existing conditions to get immediate coverage.
While insurers understand that those with pre-existing conditions will likely need medical care, how each company handles these cases varies. Here’s how pre-existing conditions can impact your health insurance:
Higher Premiums
Waiting Periods
Policy Rejection
Premium Hikes Even After the Waiting Period
Permanent Exclusions
Mandatory Medical Checkups
List of Pre-Existing Conditions Covered in Health Insurance
Most of the health insurance plans in India cover the following pre-existing health conditions:
Diabetes
Arthritis
Dengue
Hernia
Epilepsy
Obesity
Bronchitis
Cataract
Thyroid
Hepatitis
Asthma
Tuberculosis
Varicose veins
Heart disease
Blood pressure
High cholesterol
*Please note that these are general representations of pre-existing conditions covered by health policies. Proper coverage guidelines and exclusions for each disease may vary depending on the plans. Read the documents carefully before purchasing a health plan.*
List of Exclusions in Health Insurance for
Pre-Existing Conditions
Here is a list of all the pre-existing health conditions that are not covered in a health insurance policy:
What is the Waiting Period for Pre-Existing Health Conditions?
While most insurance policies in India cover pre-existing health conditions, they come with a significant waiting time. Most of them have a waiting time of 1 to 4 years. Again, this depends on the insurance plan you select.
How to Choose Health Insurance for Pre-Existing Conditions with a Shorter Waiting Period
Below are some things to keep in mind when choosing health insurance for pre-existing conditions with a shorter waiting period:
Factors to Consider Before Buying Health Policy for Pre-Existing Conditions in India
Before you purchase any insurance plan for a pre-existing health condition, here are some things to take care of:
1
Understand the Waiting Period
You will not be able to claim benefits for pre-existing conditions until the waiting period is over. Make sure to check how long you need to wait before your policy starts covering treatments. Note that any medical expenses incurred before the waiting period is over will have to be paid out of pocket.
2
Look for a Waiting Period Waiver
Some insurers allow you to waive the waiting period by paying an extra premium. However, this option depends on the severity of your illness and the insurer’s policies. Discuss this with your policy provider.
3
Full Disclosure is a Must
Always inform your insurer about any pre-existing illnesses or complications at the time of purchasing the policy. If you fail to disclose this information, the insurance company has the right to reject your claims or even cancel the policy. This could leave you financially and emotionally stressed, especially in a medical emergency.
4
Read the Fine Print
Not all policies cover pre-existing conditions and those that do usually come with certain limitations, including a waiting period. Carefully review the policy terms to avoid unpleasant surprises, such as claim rejections due to exclusions.
5
Be Prepared for Higher Premiums
If your policy covers pre-existing conditions, expect to pay a higher premium compared to plans that don’t. This is because insurers consider pre-existing conditions a higher risk.
Disclaimer
