Understanding Pre-Existing Diseases (PEDs) and Their Impact on Health Insurance
OneAssure is not just another insurance aggregator—it is a platform dedicated to finding the best policies tailored to individual needs, especially for those with pre-existing conditions..
8 min read
February 17, 2025
Jwalitha Sai Meda
Understanding Pre-Existing Diseases (PEDs) and Their Impact on Health Insurance
For individuals with pre-existing diseases (PEDs), securing health insurance is often an exhausting and disheartening journey. Constant rejections, unaffordable premiums, and complex policies make it seem impossible to find the right coverage. But what if there was a way to turn these struggles into relief?
That’s exactly what OneAssure did for Mr. Satyanarayana, a pancreatitis survivor who had lost all hope of securing a health insurance policy.
What Are Pre-Existing Diseases (PEDs)?
Pre-existing diseases (PEDs) refer to medical conditions that a person has before enrolling in a health insurance plan. These conditions can range from common issues like diabetes, hypertension, sleep apnea and asthma to severe diseases such as pancreatitis, cardiovascular disorders, and chronic kidney disease.
Insurance companies categorize PEDs as high-risk because individuals with these conditions are more likely to require frequent medical attention, hospitalization, and long-term treatments. As a result, many insurers either reject applicants with PEDs outright, impose long waiting periods, or charge excessive premiums to compensate for the perceived risk.
However, securing health insurance with a PED is not impossible. With expert guidance and the right insurer, individuals can obtain policies that provide essential coverage without unnecessary financial burdens.
The Uphill Battle: Facing Rejections at Every Step
When Mr. Satyanarayana was diagnosed with pancreatitis, his priority was ensuring financial protection for future medical expenses. However, insurer after insurer turned him away due to his PED status. Those who did offer coverage imposed unrealistic premiums and long waiting periods, making it nearly impossible for him to proceed.
Because of the pre-condition I have, it was very difficult for me to get insurance.
- Mr. VLV Satyanarana, Hyderabad
His experience is not uncommon. Many individuals with PEDs—whether it’s diabetes, heart disease, or pancreatitis—struggle to secure policies that provide adequate coverage without draining their finances.
Why Pancreatitis is a Challenge for Health Insurance
Pancreatitis is a serious condition that causes inflammation of the pancreas, the organ responsible for digestion and blood sugar regulation. It can be categorized into two types:
Acute Pancreatitis: A sudden inflammation that typically resolves with medical treatment but can lead to complications.
Chronic Pancreatitis: A long-term condition that can cause permanent damage to the pancreas, leading to digestive problems and diabetes.
Patients with pancreatitis often require frequent hospitalization, enzyme replacement therapies, and dietary modifications to manage their condition. Due to these associated risks, insurers categorize pancreatitis as a high-risk PED, leading to policy denials or restrictive terms.
Despite facing multiple rejections and long waiting periods, Mr. Satyanarayana refused to give up on securing the right health insurance. That’s when he discovered OneAssure.
With renewed hope, he turned to OneAssure, seeking expert guidance to navigate his options.
The Turning Point: OneAssure’s Personalized Assistance
OneAssure is not just another insurance aggregator—it is a platform dedicated to finding the best policies tailored to individual needs, especially for those with pre-existing conditions.
When Mr. Satyanrayana reached out, OneAssure's team took the time to understand his medical history and financial requirements. Instead of simply listing policies, OneAssure guided him through insurers that were known for being more inclusive of PED cases, such as:
HDFC ERGO:Offers PED coverage with reasonable waiting periods
Optima Secure Health Insurance Plan- Covers pre-existing diseases, including Pancreatitis, after a 36-month waiting period.
ICICI Lombard Health Insurance : Includes PEDs with manageable premium structures.
ICICI Lombard Complete Health Insurance- Covers pre-existing conditions like Pancreatitis after a 2-year waiting period.
Care Freedom Plan- Covers pre-existing diseases (PED) with a 2-year waiting period and comprehensive hospitalization benefits.
Understanding Waiting Periods for PEDs
One of the biggest hurdles for individuals with PEDs is the waiting period imposed by insurers. The waiting period refers to the time during which policyholders cannot make claims related to their pre-existing conditions. Typically, waiting periods for PEDs range from 2 to 4 years, depending on the insurer and the policy.
Here’s a quick look at some of the waiting periods offered by top insurance providers for PEDs:
This Star Diabetes Safe Insurance Plan for diabetes provides coverage to both Type 1 and Type 2 diabetes patients. It covers hospitalization due to pre-existing diabetes from day 1 under Plan A. This diabetes health insurance plan comes with a sum insured of Rs 3 lakh, Rs 4 lakh, Rs 5 lakh and Rs 10 lakh.
The HDFC ERGO Energy Health Insurance plan covers the medical expenses resulting from pre-existing diabetes and hypertension from day 1. It provides a sum insured ranging from ₹2 lakh to ₹50 lakh.
The Care Supreme Plan with Instant Cover plan offers comprehensive coverage for pre-existing diabetes, asthma, hypertension and hyperlipidemia from day 1 with the instant cover benefit. It comes with a sum insured of ₹5 lakh, ₹7 lakh, ₹10 lakh and ₹15 lakh.
ICICI Lombard Health Insurance: 2 to 3 years for PEDs, with add-on riders to reduce waiting periods.
Aditya Birla Health Insurance:
This comprehensive Aditya Birla Activ Health Platinum Essential Plan provides coverage for pre-existing diabetes, high blood pressure, asthma and high cholesterol from day 1.
Some insurers offer waivers or reductions in waiting periods if customers have prior continuous health coverage or if they opt for premium plans with added benefits. OneAssure helped Mr. Satyanarayana navigated these options, ensuring he found a policy that provided reasonable waiting periods without excessive costs.
Reducing Waiting Periods with Riders
One of the biggest concerns for people with pre-existing diseases (PEDs) is the long waiting period before they can avail of benefits. However, some insurance companies offer riders—additional benefits that can be purchased with the base policy—to reduce the waiting period. These riders come at an extra cost but can help individuals get coverage for PEDs much sooner. OneAssure also assists customers in identifying plans that offer these riders and helps them understand the cost-benefit analysis before opting for them.
Importance of Regular Health Check-Ups for PED Patients
For individuals with conditions like pancreatitis, regular health check-ups are crucial to monitor their health status. Some insurance providers offer free annual health check-ups, which can be a great advantage. OneAssure guides customers in selecting policies that include preventive healthcare benefits, ensuring they not only get coverage but also proactive healthcare management.
Cashless Claim Settlement: A Lifesaver for Patients with Pre-Existing Diseases (PEDs)
For individuals with pre-existing diseases (PEDs), the financial burden of medical treatment can be overwhelming, especially when dealing with chronic conditions that require frequent hospital visits. This is where cashless claim settlement becomes a game-changer. Instead of paying hefty medical bills upfront and waiting for reimbursement, policyholders can receive immediate treatment at network hospitals without worrying about financial constraints.
One of the biggest concerns for PED patients is the uncertainty of medical expenses, as complications can arise unexpectedly. With a cashless insurance policy, the insurer directly settles the hospital bills, ensuring that treatment is never delayed due to a lack of funds. However, it’s crucial for individuals with PEDs to choose policies that cover their condition after the waiting period and have a strong network of hospitals for hassle-free claim processing.
Many insurance providers are now offering tailored plans for individuals with PEDs, where the waiting period can be reduced through riders or wellness programs. By selecting the right policy, PED patients can not only secure financial protection but also access quality healthcare without administrative stress. With the rising cost of medical care, cashless claim settlement isn’t just a convenience—it’s a necessity for those managing pre-existing conditions.
The Importance of a Reduced Waiting Period
A shorter waiting period means quicker access to necessary medical treatments. Some insurers allow policyholders to reduce this period by:
Opting for a Higher Premium Plan – Many insurers offer plans with shorter waiting periods at a slightly higher premium.
Adding a Rider for Reduced Waiting Periods – Some policies allow waiting periods to be reduced through additional riders.
Porting from an Existing Policy – If an individual has had continuous health insurance coverage, some insurers allow waiting periods to be reduced when switching to a new plan.
Corporate Health Insurance Plans – Employer-provided health insurance often covers PEDs from day one, allowing a smoother transition to individual policies later.
Navigating Health Insurance with PED: A Step-by-Step Approach
For individuals with PEDs, getting insured doesn’t have to be an impossible task. Here are some strategies to secure the best coverage:
Compare Plans Carefully – Understand the fine print, including waiting periods, exclusions, and premium costs.
Opt for Insurers with Favorable PED Policies – Some insurers are more flexible with PEDs, as seen in the list above.
Consider Add-Ons or Riders – Some policies allow policyholders to reduce waiting periods through additional premiums.
Check Employer Group Insurance Plans – Many corporate policies offer PED coverage from day one.
Consult Experts like OneAssure – Professional guidance can help applicants navigate the complexities and find the best deals.
Why Choose OneAssure?
OneAssure stands out in the health insurance industry for its commitment to customer satisfaction. Here’s why more people are turning to them for insurance solutions:
Expert Guidance: Their team of professionals understands the complexities of health insurance and helps customers navigate the system efficiently.
Transparency: OneAssure ensures that clients understand all terms and conditions before making a decision.
Customized Solutions: They offer tailored recommendations based on individual health conditions and financial needs.
End-to-End Assistance: From policy selection to claim processing, OneAssure provides continuous support.
From Confusion to Clarity: Making the Right Choice
Unlike his previous experiences, Mr. Satyanarayana found that OneAssure simplified the entire process. Their experts helped him compare plans, understand waiting periods, and even negotiate better terms with insurers.
"OneAssure made everything so easy for me. They took care of the complicated aspects and found me a policy that actually suited my needs. I never thought getting insurance could be this simple!" Mr. Satyanarayana said.
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