Explained: Pre-Existing Disease Cover In A Group Health Insurance Policy

One of the biggest advantages of a Group Health Insurance Policy is that it can offer Pre-Existing Disease Coverage without any Waiting Period. This article will explain in detail one of the most important features of a Group Health Insurance Policy: Pre-Existing Diseases Coverage.

Contents hide

1 What is a Pre-Existing Condition in a Group Health Insurance Policy?

2 Does a Group Health Insurance Policy cover Pre-Existing Diseases from Day 1?

3 Should the employer opt for a Waiver of Waiting Period for Pre-Existing Conditions in a Group Health Insurance Policy?

4 Is a Health Check-Up required to opt for a Waiver of Waiting Period for Pre-Existing Diseases in a GMC Policy?

5 What are the important features of Group Health Insurance Policy?

6 Conclusion

What is a Pre-Existing Condition in a Group Health Insurance Policy?

The typical definition of a Pre-Existing Condition in a Group Health Insurance Policy is:

Pre-Existing Disease means any condition, ailment or injury or disease:

diagnosed by physician within 48 months prior to the effective date of the policy issued by insurer or its reinstatement or

For which medical advice or treatment was recommended by, or received from, a physician within 48 months prior to the effective date of the policy issued by the insurer or its reinstatement.

Thus, an existing medical condition or disease that the policyholder is suffering from at the time of purchase of the Group Health Insurance Policy is called a Pre-Existing Disease or Pre-Existing Condition.

The list of some of the common pre-existing diseases are asthma, diabetes, high blood pressure, cancer, thyroid, lupus, sleep apnea, epilepsy, depression and anxiety.

Does a Group Health Insurance Policy cover Pre-Existing Diseases from Day 1?

Yes, a Group Health Insurance Policy from Qian covers Pre-Existing Diseases from Day 1. Employers can opt for a waiver of Waiting Period for Pre-Existing Diseases in a Group Health Insurance Policy by paying an additional premium. This means that the Group Health Insurance Policy will offer Pre-Existing Condition Cover without any waiting period.

This is an extremely important feature of a Group Mediclaim Insurance Policy and is different from an Individual or a Family Floater Health Insurance Policy which has a Pre-existing Disease Waiting Period of 48 months and this waiting period cannot be waived off.

Waiver of Waiting Period for Pre-Existing Diseases in a Group Health Insurance Policy is a big advantage of Group Health Insurance Policy over an Individual Health Insurance Policy as an Individual or a Family Floater Health Insurance Policy has a waiting period of 3-4 years before Pre-Existing Conditions can be covered and this waiting period cannot be waived off.

If the Group Health Insurance Policy purchased by the employer covers Pre-Existing Diseases from Day 1, it will be mentioned in the Group Health Policy Certificate.

Should the employer opt for a Waiver of Waiting Period for Pre-Existing Conditions in a Group Health Insurance Policy?

Today, conditions like Diabetes, Hypertension, Cholestrol are common in a large segment of the population. If the Group Health Insurance Policy purchased by the employer has a waiting period for Pre-Existing Conditions, then lots of claims might get rejected due to this condition. Though a waiver of Waiting Period for Pre-Existing Conditions costs extra, it might be well worth it to provide a wider Group Health Insurance Coverage to employees. As always, the employers should carefully consider the pros and cons of adding or removing any feature of Group Health Insurance Policy.

Is a Health Check-Up required to opt for a Waiver of Waiting Period for Pre-Existing Diseases in a GMC Policy?

No, a Health Check-up is not required to opt for a Waiting Period Waiver for Pre-Existing Diseases in a Group Health Insurance Policy. The benefit of Group Health Insurance Policy is that the employees need not undergo any medical tests for Pre-Existing Diseases but can get coverage for Pre-Exising Conditions without any waiting period.

What are the important features of Group Health Insurance Policy?

There are numerous Group Health Insurance Providers in India which provide Group Health Insurance Plans. However, the features of these various Group Health Insurance Policies differ from one Group Health Insurance Company to another.

As a result, Employers should compare Group Health Insurance Coverages amongst the various Group Health Insurance Companies before finalising on one plan.

The important features of a Group Health Insurance Policy are as follows:

Room Rent Limit
Co-Pay Clause
Sub-Limit
Pre-Existing Disease Waiver
Waiting Periods
Domiciliary Hospitalisation Coverage
Maternity Benefits etc.

You can read our detailed blogpost on features of a Group Health Insurance Policy to learn more.

Conclusion

Pre-Existing Condition Coverage from Day 1 is an extremely important feature of a Group Health Insurance Policy. There are many advantages of a Group Health Insurance Policy such as boosting employee productivity and retention. The tax benefits of Group Health Insurance also make providing health insurance coverage to employees affordable for employers. Qian is an experienced Group Health Insurance Broker and can assist you in comparing group health insurance policies.

If you wish to purchase a Group Health Insurance Policy, you can email us at insurance@qian.co.in or call us on 022-22044989.