Testimonial: "From Rejections to Relief: How OneAssure Helped Me Find the Right Health Insurance"

Testimonial: "From Rejections to Relief: How OneAssure Helped Me Find the Right Health Insurance"

As someone living with sleep apnea, finding health insurance felt like an uphill battle. Every insurer I approached declined my application, leaving me frustrated and overwhelmed. My condition made it nearly impossible to access the luxury of comparing policies or exploring multiple options—my choices were slim to none.

The process wasn’t just discouraging; it was also opaque and time-consuming. Every interaction seemed to drain my bandwidth, with endless paperwork and vague answers that left me more confused than confident.

Then I found OneAssure, and everything changed. Their team of advisors stepped in with empathy and expertise, turning a stressful experience into a seamless one. They took the time to understand my condition and worked tirelessly to identify a policy that would cover my unique needs.

Within days, I had a tailored health insurance plan in place—something I thought was impossible just weeks before. The transparency and professionalism they brought to the table were unparalleled, making the entire process stress-free and straightforward.

OneAssure didn’t just help me find a policy; they gave me peace of mind. For anyone struggling with pre-existing conditions like sleep apnea and feeling stuck, I can’t recommend them enough. They truly make the impossible possible!

• Siddhartha Saha

Health Insurance Plans for Pre-Existing Diseases: A Complete Guide with Real-Life Insights

For millions of Indians, securing health insurance is a critical step toward financial stability. However, for those with pre-existing diseases (PEDs) like sleep apnea, the journey can feel like navigating a maze. From long waiting periods to limited policy options, challenges abound. This blog aims to provide a detailed guide to health insurance plans for pre-existing diseases in India, weaving in a real-life success story of overcoming these hurdles with OneAssure. 

What Are Pre-Existing Diseases in Health Insurance?

A pre-existing disease (PED) is any medical condition diagnosed, treated, or noted in a person’s medical history before purchasing a health insurance policy. According to the IRDAI, any condition identified within 36 months before buying the policy is classified as pre-existing.

Common Pre-Existing Diseases in India

Following are a few common PEDs:

• Diabetes
• Hypertension
• Asthma
• Thyroid Disorders
• Heart Diseases
• Sleep Apnea

Real-Life Example: Tackling Challenges with Sleep Apnea as a Pre-Existing Disease

Imagine the frustration of having your health insurance applications repeatedly declined due to a pre-existing condition like sleep apnea. This was the experience of Siddhartha Saha, a OneAssure customer who faced immense challenges in finding coverage.

The Problem

• Health insurance policies were declined everywhere due to sleep apnea.
• The insurance process was opaque, requiring significant time and effort.
• No luxury of choice or comparison.

The Solution: OneAssure

By reaching out to OneAssure, Siddhartha found an advisor who simplified the process and identified a suitable policy. Although the condition limited available options, the OneAssure team ensured the process was stress-free and transparent.

Best Health Insurance Plans for Pre-Existing Diseases in India

Finding the right policy involves comparing options across providers. Below are some plans that cater to individuals with PEDs:

1. Star Health Insurance

• Family Health Optima: Offers PED coverage after 48 months.

2. HDFC ERGO Health Insurance

• Optima Restore: Coverage after a 36-month waiting period.

3. ICICI Lombard Health Insurance

• ICIC Elevate: provides flexibility by allowing the reduction of the pre-existing disease (PED) waiting period to as low as one or two years, and the waiting period for specific diseases to just one year.

How to Choose the Best Health Insurance for Pre-Existing Diseases in India

Selecting the right health insurance plan for pre-existing diseases (PEDs) requires careful consideration of several critical factors. Each policy has unique terms, and understanding these is key to finding one that meets your specific healthcare and financial needs. Refer to the following guide to make the best choice:

1. Review Waiting Periods for Pre-Existing Conditions

The waiting period is the time you must wait before your insurer begins covering expenses related to your PED. In India, this period typically ranges from 12 to 48 months, depending on the insurer and plan. For individuals with urgent healthcare needs related to PEDs, shorter waiting periods can be a lifesaver.

• Star Health’s Comprehensive Plan: Has a 36-month waiting period for pre-existing diseases, making it a good choice for people who want mid-term coverage.
• HDFC ERGO Health Suraksha Plan: A longer waiting period of 48 months, but the policy offers extensive coverage after the waiting time ends.

Pro Tip: If you don’t currently have a PED but are at risk of developing one (due to family history or lifestyle), purchase a policy early to exhaust the waiting period before the condition develops.

2. Consider Premiums and Co-Payment Clauses

Premiums for health insurance plans covering pre-existing diseases are typically higher because of the additional risk insurers assume. It’s essential to compare premiums across insurers to ensure affordability while not compromising on coverage.

• Premium Costs: For instance, ICICI Lombard’s Complete Health Insurance Plan may charge higher premiums for individuals with chronic conditions like diabetes or heart disease.
• Co-Payment Clauses: Some policies, such as Care, may require you to co-pay a percentage of the expenses related to your PED. This could range from 10% to 30%, depending on the insurer.

Pro Tip: If you are financially stable and prefer lower premiums, a plan with co-payment might work well. However, if you prefer comprehensive coverage with minimal out-of-pocket expenses, prioritize no or low co-payment policies.

3. Check Network Hospitals for Cashless Treatment

The availability of network hospitals is a crucial factor in selecting health insurance. Network hospitals offer cashless treatment, where the insurer directly settles your bills with the hospital. This ensures that you don’t need to pay out of pocket during medical emergencies.

• Wide Network Coverage: Plans like Max Bupa’s ReAssure and ManipalCigna ProHealth Plus provide access to an extensive list of hospitals for cashless claims.
• Convenience: Ensure the hospitals on the network list are located near your home or workplace for easy access during emergencies.

Pro Tip: Always check if the hospitals offering specialized care for your PED (e.g., cardiology for heart diseases, endocrinology for diabetes) are included in the insurer’s network.

4. Understand Coverage for Complications

Pre-existing conditions often lead to complications or related health issues that may require additional treatments or surgeries. For example:

• Diabetes: Could lead to complications like kidney damage or cardiovascular issues.
• Heart Diseases: May result in costly procedures like bypass surgery or angioplasty.
• Asthma: Could lead to severe respiratory infections requiring hospitalization.

Review the policy documents carefully to ensure these associated complications are covered. Plans like Star Health’s Family Health Optima often include a broad range of treatments for such complications post the waiting period.

Pro Tip: Speak to your insurer or advisor, like OneAssure, to confirm whether secondary health issues related to your PED are included in the coverage.

6. Seek Expert Guidance

The health insurance landscape in India can be overwhelming, particularly for those dealing with PEDs. Insurers often have opaque processes, making it challenging to understand terms or compare plans effectively. Consulting experts like the advisors at OneAssure can simplify the process.

• OneAssure Advantage: Our team evaluates your specific health and financial needs to identify policies that suit you, saving time and effort.
• Customer Testimonial: As highlighted earlier, OneAssure successfully helped an individual with a sleep-related PED find a policy after multiple rejections from other insurers.

Pro Tip: Engage with advisors early in the process to avoid pitfalls and ensure you choose the most suitable plan.

7. Consider Additional Benefits and Features

Look for policies offering extra benefits that can enhance your overall coverage. For example:

• Reset Benefit: In some cases, reset benefit does not apply if the same illness recurs within the same policy period, ensuring fair coverage utilization. For example, ICICI. 
• No Claim Bonus (NCB): Many insurers, like Star Health, offer a bonus for claim-free years, increasing your sum insured without additional premiums.
• Wellness Programs: Some insurers include programs that help manage PEDs through fitness tracking, regular health check-ups, or teleconsultations.

Pro Tip: Choose a policy that encourages proactive health management, especially if you have a condition like diabetes or hypertension.

Why Early Planning and Transparent Disclosure Are Critical for Health Insurance with Pre-Existing Diseases

When it comes to health insurance for pre-existing diseases (PEDs), early planning and honest disclosure are non-negotiable. They are not just administrative necessities; they serve as essential steps to secure comprehensive, long-term coverage. Let’s dive deeper into why these aspects are critical and how they can impact your insurance journey.

1. Early Planning Helps You Overcome Waiting Periods

The waiting period for pre-existing diseases in health insurance policies can range from 12 to 48 months. During this time, claims related to PEDs are not covered. Early planning helps in minimizing the impact of these waiting periods because:

• Time on Your Side: If you secure a policy before developing symptoms or being diagnosed with a PED, you can exhaust the waiting period while you’re still healthy. For example, if you have a family history of diabetes, purchasing a policy before diagnosis ensures you’re covered when the condition arises.
• Avoid Delays in Treatment: Once the waiting period is over, you can access timely treatments without worrying about financial constraints, especially for chronic conditions like hypertension or asthma.

2. Transparent Disclosure Prevents Claim Rejections

Many individuals are tempted to withhold information about pre-existing diseases when purchasing health insurance. While this might seem like a shortcut to getting cheaper premiums, it’s a risky approach that often backfires. Transparency is critical because:

• Insurance Companies Cross-Verify: Insurers thoroughly evaluate your medical history during the claims process. If they discover undisclosed pre-existing conditions, your claim may be rejected, leaving you without financial support during emergencies.
• Maintains Policy Validity: Non-disclosure of PEDs can result in the cancellation of your policy altogether. Insurers like Star Health and HDFC ERGO explicitly state in their terms that inaccurate declarations are grounds for termination.

3. Accurate Medical History Ensures the Right Coverage

When you disclose your medical history transparently, it enables insurers and advisors like OneAssure to recommend the most suitable policies. Without this information, you risk:

• Choosing Inadequate Coverage: Some policies may not cater to the specific needs of your condition, such as frequent hospital visits for diabetes management or post-operative care for cardiac issues.
• Missing Out on Specialized Plans: For instance, insurers like ICICI Lombard and Max Bupa offer policies designed for individuals with chronic conditions. These plans may include features like wellness programs, regular check-ups, or condition-specific coverage.

4. Peace of Mind and Financial Security

Being honest about your pre-existing diseases ensures peace of mind. You won’t have to worry about claim rejections, disputes, or hidden clauses. This transparency ultimately translates into better financial security, especially when dealing with costly medical treatments.

• For Chronic Diseases: Conditions like diabetes, asthma, or thyroid disorders often require long-term management, including medications and regular diagnostics. A well-structured health insurance plan ensures these expenses don’t strain your finances.
• For Emergency Situations: If you suddenly need surgery or hospitalization for complications arising from your PED, your disclosed and approved insurance policy will act as a financial safety net.

5. Builds a Strong Relationship with Your Insurer

When you’re upfront about your health, you foster trust with your insurance provider. This trust can lead to better customer service and smoother claim processing. Companies like Star Health, HDFC ERGO, and ManipalCigna prioritize seamless experiences for transparent policyholders.

How OneAssure Helps You Navigate Early Planning and Disclosure

 The insurance advisors at OneAssure understand the complexities of securing coverage for pre-existing diseases. They guide customers to:

• Identify the Right Policy: OneAssure evaluates your medical history and recommends plans with the most suitable waiting periods, coverage, and premiums.
• Simplify the Process: They assist with paperwork, ensuring that your disclosures are accurate and complete, reducing the risk of claim disputes.
• Provide Stress-Free Solutions: As seen in the testimonial, OneAssure helped a customer with a sleep-related PED navigate rejections and find a policy tailored to their needs.

Final Thoughts: Plan Early, Disclose Honestly

Early planning and transparent disclosure are the cornerstones of securing the best health insurance plan for pre-existing diseases. They not only minimize waiting periods and ensure coverage but also safeguard you from the stress of claim rejections or policy cancellations.

Take control of your health and finances today. Engage with trusted advisors like OneAssure to simplify the process, and ensure you’re prepared for whatever health challenges come your way.

Book a free call with OneAssure today! Read our other insurance related blogs for more information.