What to Do if You Forget to Declare Your Pre-Existing Condition in Health Insurance


Imagine you’ve been experiencing some worrying symptoms for a few months but are afraid to see a doctor because you don’t have health insurance. After some research, you decide to buy an affordable health insurance plan for yourself or your family that offers the coverage you need.

However, when filling out the application, you leave out some details about your symptoms, fearing it will raise your premium or lead to your application being denied. You get approved for the policy, but a few months later, you’re diagnosed with a serious condition that requires expensive treatment.

Unfortunately, your insurance might not cover the treatment costs because you didn’t disclose your symptoms. Let’s explore the consequences of not reporting pre-existing medical conditions and how to avoid these issues.

Understanding Pre-Existing Conditions

A pre-existing condition is any health issue or illness you had before your health insurance coverage began. These can include chronic diseases like diabetes, hypertension, asthma, and heart conditions. Most health insurance plans require you to declare any pre-existing conditions during the application process.

Importance of Declaring Pre-Existing Diseases

Declaring pre-existing diseases is crucial for several reasons:

  1. Honesty: Insurance companies rely on your disclosure to assess risk and determine premiums.
  2. Avoiding Claim Rejection: Undeclared pre-existing conditions can lead to claim rejections if discovered later.
  3. Legal Compliance: Non-disclosure can be seen as a breach of the insurance contract.

What If You Forget Declaring Your Pre-Existing Condition While Buying Health Insurance?

Firstly, suppose you file a claim, and the health insurance company finds out that it is for an illness you didn’t disclose. In that case, they can deny it or even cancel your health insurance. They can discover these details while checking papers related to the already existing condition.

Secondly, even if the claim you file is not related to the undisclosed illness, the insurer can cancel your policy.

Third, suppose you didn’t disclose pre-existing conditions or serious illnesses that need regular treatment. In that case, you won’t be covered for those conditions. With healthcare costs rising, medical bills can be very expensive, especially if your claim for a pre-existing condition is denied.

However, suppose you have been paying your premiums for 8 years without a break, and a pre-existing condition is discovered after this period. In that case, the insurance company cannot cancel your policy.

What’s the Solution If You Forget Declaring Your Pre-Existing Condition?

Not disclosing pre-existing medical conditions when buying health insurance can lead to serious issues, but there are ways to fix it:

  1. Correct During Free-Look Period: Once you purchase a health insurance policy, you have a free-look period (usually 15 days) to modify, cancel, or rectify any details. Use this time to declare any undisclosed health information. The insurer will update the policy according to their guidelines.
  2. Disclose at Renewal: If the free-look period has passed, you can still divulge your health condition when renewing the policy. The insurer can accept the latest information, resume the coverage, charge a higher premium, remove the condition, or even terminate the policy.
  3. Buy a New Policy: You can switch to another provider and honestly declare your medical conditions or purchase a new health insurance policy to get coverage for pre-existing diseases.

Additionally, suppose you have paid premiums continuously for 8 years. In that case, the insurer cannot cancel the policy for pre-existing conditions discovered after this period.

Key Points to Remember

  1. Transparency: Always be transparent about your medical history when buying a health insurance policy.
  2. Regular Updates: If your health status changes or you develop new conditions, inform your insurer.
  3. Document Everything: Keep records of all medical reports and communication with your insurer regarding your pre-existing condition.

How to Choose the Right Health Insurance Plan for Pre-Existing Conditions?

When shopping for health insurance, especially with pre-existing conditions, consider the following:

  1. Comprehensive Coverage: See policies offering extensive health coverage for preexisting conditions, including hospitalisation, outpatient care, and medications.
  2. Waiting Period: Compare the waiting periods of different plans. Some plans might offer shorter waiting periods for pre-existing conditions.
  3. Family Health Insurance: If you are buyingfamily health insurance, ensure the plan adequately covers pre-existing conditions for all family members.
  4. Specialised Plans: Some insurers offer special plans tailored for pre-existing conditions like diabetes or heart disease. These plans might offer better coverage and terms.
  5. Premiums and Benefits: Balance the premium costs with the benefits provided. Ensure that the plan you choose offers good value for money.

Final Word

When purchasing a health insurance policy in India, you can rectify the mistake of forgetting to declare a pre-existing condition by promptly contacting your insurer and being transparent. This proactive approach can help you avoid claim rejections and ensure that your health coverage remains intact.

Thorough research and understanding of the policy terms are crucial when choosing a health insurance plan, especially for pre-existing conditions. Remember, honesty and clarity with your insurance provider are key to maintaining a reliable health insurance plan that effectively safeguards your health and financial well-being.