The Impact of Pre-existing Medical Conditions on Critical Illness Health Insurance Coverage

The advantages of having health insurance are numerous. It gives you peace of mind, offers you an inexpensive alternative to excessive medical expenditures, and ultimately, it assures that you never sacrifice your health out of a lack of money. It offers you financial protection against unforeseen circumstances and medical crises. Health care coverage provides a number of advantages, but it also comes with limitations. One of these is the pre-existing condition coverage.

Several people today struggle with lifestyle pre-existing ailments such as thyroid, obesity, diabetes, hypertension, and others. This is partly because of the increased stressors in our environment and our indulgence in things like smoking, drug use, and alcohol addiction that worsen these illnesses. 

But, pre-existing conditions are specifically covered by the best critical illness policy in India. It’s crucial to understand a few specifics about how insurance companies handle these conditions and what you need to know about pre-existing condition health insurance before you get a plan for your family. Read on to know more. 

It falls under the umbrella of fixed benefit plans and is a form of health insurance. If the insured person is diagnosed with one of the critical illnesses covered by the policy, they will get a certain sum of money. The coverage offers financial support for the management of various illnesses, such as heart attack or stroke, cancer, loss of arms or legs, etc. As a result, critical insurance helps to manage medical costs without draining the wallet or interfering with other financial commitments.

Health Insurance For Pre-Existing Conditions

According to a circular released by the Insurance Regulatory and Development Authority of India (IRDAI) on February 10, 2020, a pre-existing sickness is a medical condition, ailment, disease, or injury that the insured person had prior to acquiring the best critical illness policy in India. Any such medical condition is classified as pre-existing if it was discovered by a physician 48 months before the policy’s issuance or reinstatement date.

This decision dramatically altered how the pre-existing critical illness insurance plans in the industry worked. This has helped those with a more positive outlook on purchasing insurance by dramatically lowering the rejection rate.

Given how unforeseen health-related problems are, no matter how much planning and rigorous preparation you put in place, you are still susceptible to various illnesses, not to mention accidents. Thus, it is prudent to have proper healthcare coverage to give you financial security from such diseases. A basic health plan might not guarantee you enough medical coverage, though, given that medical inflation is continually on the rise. Due to this, getting critical illness insurance coverage is an ideal choice one can make. 

Impact of Pre-existing Medical Conditions on Critical Illness

The impact of pre-existing medical conditions on critical illness insurance coverage can vary depending on the insurer and the specific condition. Here are some key pointers to consider:

Underwriting Process

The underwriting process is the process by which insurance companies assess the risk of insuring an individual. This process involves evaluating the individual’s medical history, including any pre-existing conditions. If an individual has a pre-existing medical condition, the insurance company may consider them to be a higher risk, which could result in higher premiums or a denial of coverage altogether.

Type and Severity of the Pre-existing Condition

The type and severity of the pre-existing condition can also impact critical illness plans India. Some conditions, such as cancer or heart disease, may make it more difficult to obtain coverage or may result in higher premiums. However, other conditions, such as minor allergies, may have little or no impact on insurance coverage.

Waiting Periods

Many critical illness insurance policies have waiting periods before coverage begins. During this time, the policyholder will not be eligible to receive a payout for any critical illness diagnosis. For individuals with pre-existing medical conditions, the waiting period may be longer or may exclude coverage for certain conditions.


In some cases, insurance companies may exclude coverage for pre-existing conditions altogether. This means that if an individual is diagnosed with a critical illness related to their pre-existing condition, they will not be eligible to receive a payout. These exclusions can vary depending on the insurer and the specific condition.


Individuals with pre-existing medical conditions may be subject to higher premiums for critical illness insurance coverage. This is because insurance companies consider them to be a higher risk than individuals without pre-existing conditions. The amount of the premium increase will depend on the type and severity of the pre-existing condition.

It’s important to note that not all insurance companies treat pre-existing conditions the same way. Some insurers may be more willing to provide coverage for individuals with pre-existing conditions, while others may have more stringent underwriting criteria. As a result, it’s important to shop around and compare policies from multiple insurers before making a decision.

It is undeniable that your health is one of the many things over which you have limited control. Although it is impossible to manage your health fully, both now and in the future, investing in quality health insurance coverage will help you make substantial progress. Even with the best medical insurance, you may need adequate coverage when diagnosed with a critical illness. A standard health policy does not cover acute diseases like cancer, heart attacks, or paralysis. As a result, choosing the best critical illness plan is a wise decision to make.

The elements of the best critical illness plan are essentially the same for both standalone insurance plans and riders on health insurance plans. The form you choose to purchase entirely relies on your particular preferences. Yet experts at Niva Bupa claim that it functions best when added as a rider to the best critical illness plan. Moreover, filing a claim under a critical illness health policy involves understanding your policy, obtaining medical evidence, notifying your insurer, completing a claim form, waiting for a decision, and receiving your payment. By following these steps and working closely with your insurer, you can ensure that you receive the coverage you need when you need it most.

Overall, the impact of pre-existing medical conditions on critical illness insurance plans can be significant. Individuals with pre-existing conditions may find it more difficult to obtain coverage or may be subject to higher premiums or exclusions. However, with careful research and comparison, it is still possible to find coverage that meets your needs and budget. Niva Bupa can help you choose the best critical illness policy in India that meets your needs and includes coverage for a variety of pre-existing conditions so you never have to worry about money and can get the greatest medical treatment when you need it.