How to get insured if you have a pre-existing health condition

Last month a friend called to say that she had forgotten to renew her health insurance. With the break, the insurer refused to renew her cover because she had previously had cancer. A decade ago, I often urged people to buy health insurance. Some felt that medical costs were manageable. Others opined that claims would not be paid. That worldview has changed because medical inflation is in plain sight and millions have benefited from insurance.

Today, people worry most about how to get insured if they have been diagnosed with a health condition. They shouldn’t. Insurers are now good at understanding and insuring people with adverse health. These are recorded in the policy as ‘pre-existing health conditions’. But what does this technical phrase mean?

Standardized in 2020

There was a time when every insurer had their own definition of ‘pre-existing condition’, some so elastic that any claim could be dismissed. This changed in 2020, when the regulator defined this phrase and asked insurers to consistently follow its definition. It was now mandated that the disease should have been diagnosed or treated not more than three years before buying insurance. That put an end to scrambling for your childhood medical records. It also said you should have been diagnosed with an ailment for it to be considered a pre-existing condition. No longer was it good enough to just have had the symptoms.

A frequent query from those suffering chronic ailments such as hypertension, high cholesterol or thyroid disorders is: How much should I disclose to insurers? The underlying concern is that they may not be given insurance if they are completely honest. That is not true.

Insurers can factor in ailments in many ways. For moderate chronic conditions they will issue a standard policy with the health issues listed and excluded from coverage for two to three years. Those who have underdgone surgical interventions such as hysterectomy, appendicitis, gall bladder or kidney stone removals will also be insured in the standard mediclaim plans.

For more serious chronic conditions, the insurer may increase annual premiums, often by 10 to 20%. In very severe situations the insurer could permanently exclude a disease. Sometimes insurers suggest alternative plans with lower coverage or with co-payment. The important point is that insurers can and do accommodate pre-existing conditions in ways that are fair to policyholders and insurers alike.

Step-by-step guide

Here are the steps you should take if you have a pre-existing illness.

Cast the net wide and reach out to at least five insurers. Pick a standalone health insurer, as well as a private-sector and a public-sector insurer. They can have very different approaches to risk assessment.
Speak to a person from the company rather than depending entirely on a digital interface. I have seen many insurance underwriters change their decision when someone explains a nuance to them.
Disclose information transparently but not excessively. The questions that you are asked are precise. Answer just those questions. Someone I know did not get insurance because he spoke expansively about all the people in his family that had mental health issues. The objective is to answer honestly, but only what is asked, so the insurer is comfortable with issuing the policy.
Be open to counter-offers, revised product recommendations, modifications in sum assured and higher premiums. It is better to have some insurance than none at all. Products available today must meet minimum regulated standards.
Don’t try to club all family members into one family floater. It is best to make sure that someone with a pre-existing condition has a standalone insurance plan tailored to them. A specific plan for each person is better than a single average plan for all.
If you are not able to get a personal insurance, evaluate the affinity group insurance that is increasingly becoming available. Many universities offer these to alumni, and foundations and banks also have such products. The advantage of these affinity insurance is that generally no medical underwriting is done. These plans do not have the regulatory protection of lifelong renewal that personal insurance plans have, and prices and benefits can change each year. But it is a good backup.
Lastly, once you have an insurance plan, please learn from my friend’s mistake and renew it on time.

This brings up a related concern. Some months ago, a colleague called to share that his daughter had turned 25. Should he inform the insurer of her occasional, social drinking? No. Changes to your habits, circumstances and health conditions after you have bought the insurance do not need to be shared with the insurer routinely.

Ultimately, the smartest thing that you can do is buy health insurance today, and then renew well before time each year. It’s also a good idea to review your insurance plan and to check your options every few years.

As for my cancer-survivor friend who lost her insurance, she did manage to buy a new plan but with cancer permanently excluded. I am quite certain she won’t let her insurance lapse again.

Kapil Mehta is co-founder of SecureNow, an insurance broker.