How does pre-existing diseases get covered in Group Health Insurance?
One of the big advantages of buying Group Insurance for health (Group Mediclaim) is that then benefits can be significantly enhanced over a standard policy. One such benefit that most companies take while buying Group Insurance is the pre-existing diseases. Below are few common questions asked regarding the pre-existing disease.
What is Pre-Existing disease?
A pre-existing disease is an ailment or signs of ailment that was present before the inception of the insurance policy. For example, if someone had a heart attack, then most cardiovascular ailments would be classified as pre-existing diseases. Sometimes when the person is suffering from severe blood-pressure abnormalities, it could be used to classify cardio-vascular problem as a pre-existing disease.
Are pre-existing diseases covered in a standard health insurance?
Most Insurance companies would cover pre-existing diseases after the insured has been in the policy for 4 years. Some companies would have a lower criteria of 3 years. In some extreme cases, before the policy is issued the pre-existing disease is mentioned as a permanent exclusion. The rationale behind this condition is to prevent misuse / fraud i.e., people should not buy an insurance only to cover known ailments.
Can pre-existing be covered from Day 1 in Group Health Insurance?
Yes. One of the ways in which group insurance can prove beneficial is that pre-existing diseases are covered from Day 1 for all members. Since group insurance is purchased for numerous families together, the chances as well as impact of fraud are considerably reduced. Hence this benefit can be offered by Insurance companies.
Should we go for pre-existing disease waiver?
It depends on the demographic to be covered and the benefits you want to offer to your group members. For instance, if the group is of very young members with a clean medical history and the coverage is limited to self only, then the benefit has relatively less importance. On the other hand, if the group has an average age of 40 with parents covered, then the significance of this benefit is much more.
Moreover, it depends on the policy of the group and the cost it wants to incur. Some groups might want to entitle their members for this benefit only after they have been with the system for 4+ years. At the same time, this benefit comes only at an additional cost.
Designing a group insurance policy means weighing several implications together. It is best to take an independent professional’s advice to execute on this. To take services of SecureNow, please contact us.
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