pre existing diseases in health insurance

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Deal Subedar
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I bought Tata health insurance for my parents.
in the policy form i clearly wrote diabates- in control as a pre existing disease for my mother but in the policy that i received the pre-existing tab is blank.
I contacted tata’s customer support on call and they said that it’s not a problem as it will be covered after 2 years, the agent also gave the same reply.
What should i do now? i am a little bit worried as this can be used by tata to reject my claim in future saying non closure of preexisting disease.

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Ask them to update the propoal document with clearly mentioning ‘Diabates as associated complications’ under Pre Exisiting diseases. Else, they will reject your claims on later date stating pre existing disease not declared. Make sure you mention each & every detail in pre existing disease.

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+ @drjpatwa
My friend had a ruptured nerve in brain due to some trauma. He didn’t have medical insurance. When he tried to get it done after the hospitalization, the agent said that if you mention this under per-existing diseases all your future claims relating to this will be rejected because things related to mind and heart are easy to reject. So, he advised to not mention it and if God forbids he needs to claim about this disease after the cooling off period, he should visit some new hospital and not mention anything about the old hospitalization. He is about 31 years old. He contacted some private company directly and was given the same answer. How should he proceed?

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Don’t rely on verbal words. At the time of dispute they don’t have any value. Ur claim will get rejected.

If u have filled form with u, ask company & agent to give Endorsement letter mentioning Diabetes as pre-existing disease. Endorsement letter is official legal document for any change done in policy copy at later date.

If they deny for it (which they won’t, if u follow up with them) & still u r in 1st 15 days of policy purchase then terminate policy in 15 days to get full refund.

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billubakra wrote:

+ @drjpatwa
My friend had a ruptured nerve in brain due to some trauma. He didn’t have medical insurance. When he tried to get it done after the hospitalization, the agent said that if you mention this under per-existing diseases all your future claims relating to this will be rejected because things related to mind and heart are easy to reject. So, he advised to not mention it and if God forbids he needs to claim about this disease after the cooling off period, he should visit some new hospital and not mention anything about the old hospitalization. He is about 31 years old. He contacted some private company directly and was given the same answer. How should he proceed?

@billubakra

I usually advise people that don’t lie to company bcoz at the time of claim it might affect company’s decision in passing claim. But there are always such tricky conditions – Where either customer don’t want to disclose disease (like diabetes, BP etc.) Because of loading & waiting period. Also as u mentioned, in such condition where by disclosing disease, company might reject application. So in such condition we have to play very very smartly. I advised in such cases what 1 should do to get claim settled without caught from company’s team (Without any guarantee. Risk will be of customer).

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All pre-existing diseases have exclusion period of 2 years. They get covered after you pay the 3rd year premium. Even if its not mentioned, after 2 years, they cannot reject claim on this ground,.

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panchabhut wrote:

All pre-existing diseases have exclusion period of 2 years. They get covered after you pay the 3rd year premium. Even if its not mentioned, after 2 years, they cannot reject claim on this ground,.

Majority plan covers PED after 3-4 years.

& NO. They will reject the claim 100% if they come to know that it was PED even if u take claim on 5th or 6th year. Because it is company’s decision whether to issue policy or not to PED. Even if they issue many of them applies loading (charging extra premium).

& Even if they don’t apply loading it is breach of trust.

Not only they reject claim, they can terminate policy inbetween stating material facts have been hide.

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drjpatwa wrote:

Majority plan covers PED after 3-4 years.

& NO. They will reject the claim 100% if they come to know that it was PED even if u take claim on 5th or 6th year. Because it is company’s decision whether to issue policy or not to PED. Even if they issue many of them applies loading (charging extra premium).

& Even if they don’t apply loading it is breach of trust.

Not only they reject claim, they can terminate policy inbetween stating material facts have been hide.

Is it true that Insurance companies won’t give you any policy for pre-existing diseases like CKD, CLD even with 2/4 years waiting period?

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getready wrote:

Is it true that Insurance companies won’t give you any policy for pre-existing diseases like CKD, CLD even with 2/4 years waiting period?

Yes majority of company won’t give policy to CKD, CLD patients. Still they can try.

Star health has some innovative products for cardiac patients (also religare have such plan), cancer patients. I Really appreciate their step.

However I haven’t come across any such policy for CKD, CLD.

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drjpatwa wrote:

@billubakra

I usually advise people that don’t lie to company bcoz at the time of claim it might affect company’s decision in passing claim. But there are always such tricky conditions – Where either customer don’t want to disclose disease (like diabetes, BP etc.) Because of loading & waiting period. Also as u mentioned, in such condition where by disclosing disease, company might reject application. So in such condition we have to play very very smartly. I advised in such cases what 1 should do to get claim settled without caught from company’s team (Without any guarantee. Risk will be of customer).

Thanks. How much is the cooling off period for the diseases related to the brain and heart? Also is it same in all insurance companies?
This cooling off/loading, unloading period, is it prevalent all around the world?

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drjpatwa wrote:

Majority plan covers PED after 3-4 years.

& NO. They will reject the claim 100% if they come to know that it was PED even if u take claim on 5th or 6th year. Because it is company’s decision whether to issue policy or not to PED. Even if they issue many of them applies loading (charging extra premium).

& Even if they don’t apply loading it is breach of trust.

Not only they reject claim, they can terminate policy inbetween stating material facts have been hide.

Not only they reject claim, they can terminate policy inbetween stating material facts have been hide.
But if something is not hidden then do these companies reject claims related to the brain and heart if it’s mentioned fully? Do they usually reject claims like these? What have you seen as per your experience? I get your point from the earlier post that the customer will have to bear the risk. They surely do charge way more premium if the same is told to them.

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billubakra wrote:

+ @drjpatwa
My friend had a ruptured nerve in brain due to some trauma. He didn’t have medical insurance. When he tried to get it done after the hospitalization, the agent said that if you mention this under per-existing diseases all your future claims relating to this will be rejected because things related to mind and heart are easy to reject. So, he advised to not mention it and if God forbids he needs to claim about this disease after the cooling off period, he should visit some new hospital and not mention anything about the old hospitalization. He is about 31 years old. He contacted some private company directly and was given the same answer. How should he proceed?

I strongly advise to never hide previous hospitalization/history of illness/pre existing diseases or medications to a doctor ever. History is a very important part of check-up and further treatment. Even the minutest detail could be very important.

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mas143forever wrote:

I strongly advise to never hide previous hospitalization/history of illness/pre existing diseases or medications to a doctor ever. History is a very important part of check-up and further treatment. Even the minutest detail could be very important.

What about the agent and the insurance company saying that they are sure that the company will reject all further claims. I mean my friend doesn’t want to hide anything but people related to that industry are saying otherwise.

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billubakra wrote:

What about the agent and the insurance company saying that they are sure that the company will reject all further claims. I mean my friend doesn’t want to hide anything but people related to that industry are saying otherwise.

I cant say about insurance tips tricks, as i am not aware about them. That he will have to see.

But never hide health details and history when getting a check-up or visiting a doctor. This i can tell about. And in this case, his history is quite significant form what you told (ruptured nerve? Must have been something else,not nerve, but significant nonetheless).

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mas143forever wrote:

I cant say about insurance tips tricks, as i am not aware about them. That he will have to see.

But never hide health details and history when getting a check-up or visiting a doctor. This i can tell about. And in this case, his history is quite significant form what you told (ruptured nerve? Must have been something else,not nerve, but significant nonetheless).

Matlab sach bol ke bhi pakka nahi ki claim pass hoga ki nahi. Maha lodu rules.
It’s a stroke in the lateral medulla, I think some blockage to be precise and not a ruptured nerve like I mentioned earlier.

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billubakra wrote:

Not only they reject claim, they can terminate policy inbetween stating material facts have been hide.
But if something is not hidden then do these companies reject claims related to the brain and heart if it’s mentioned fully? Do they usually reject claims like these? What have you seen as per your experience? I get your point from the earlier post that the customer will have to bear the risk. They surely do charge way more premium if the same is told to them.

If u mention about it, I see a very bleak chance of the company issuing policy. Fir claim ki to baat he nhi hai…

For heart related matter, they can try with star or religare’s cardiac plan. Don’t aware about any such plan for Brain. That too stroke in lateral medulla !!!

@billubakra

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billubakra wrote:

Matlab sach bol ke bhi pakka nahi ki claim pass hoga ki nahi. Maha lodu rules.
It’s a stroke in the lateral medulla, I think some blockage to be precise and not a ruptured nerve like I mentioned earlier.

Only option is to get a policy when a person is disease free.

Someone here started the thread, what is right age to buy health insurance. Answer is when u r disease-free & U never know when u r going to get disease (No one wants it as such).

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Can someone confirm if PED should be declared for mediclaim (corporate policy ) and all? Im getting 3L mediaclaim from company (yet to join ) and planning to take 7L addon because of existing covid issues.
Im asking about the company’s medical policy (mediclaim in my case)

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Hi, I am new to this insurance. Can someone help me out, plz.

I pay 15k for my mother insurance via TCS company and insurance company is new india assurance. My mother is suffering from urinary infection, visited couple of big hospitals twice but no use. Kamineni hospital is asking like 20k for some lab tests, but since this is not a admission case, can i use insured amount of 2l? I already used domiciliary claim of 6k. Since the amount is more than 20k(who knows how much these people might ask later again) i am in a dilemma what to do. Any experience, plz share. These hospitals r charging 800 per visit!! This is insane..

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drjpatwa wrote:

If u mention about it, I see a very bleak chance of the company issuing policy. Fir claim ki to baat he nhi hai…

For heart related matter, they can try with star or religare’s cardiac plan. Don’t aware about any such plan for Brain. That too stroke in lateral medulla !!!

@billubakra

Would you recommend any company the policy of which he should atleast apply for? And it is Wallenberg Syndrome. + @mas143forever

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drjpatwa wrote:

Only option is to get a policy when a person is disease free.

Someone here started the thread, what is right age to buy health insurance. Answer is when u r disease-free & U never know when u r going to get disease (No one wants it as such).

So, there’s nothing that can make up for the mistake, of not getting one when a person is disease free?

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jitz wrote:

Can someone confirm if PED should be declared for mediclaim and all? Im getting 3L mediaclaim from company (yet to join ) and planning to take 7L addon because of existing covid issues.

Read my posts and replies given by members above.

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rr914 wrote:

Hi, I am new to this insurance. Can someone help me out, plz.

I pay 15k for my mother insurance via TCS company and insurance company is new india assurance. My mother is suffering from urinary infection, visited couple of big hospitals twice but no use. Kamineni hospital is asking like 20k for some lab tests, but since this is not a admission case, can i use insured amount of 2l? I already used domiciliary claim of 6k. Since the amount is more than 20k(who knows how much these people might ask later again) i am in a dilemma what to do. Any experience, plz share. These hospitals r charging 800 per visit!! This is insane..

Unfortunately hospitalization is needed.
@drjpatwa

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billubakra wrote:

Read my posts and replies given by members above.

Don’t think anyone commented on a corporate policy. I’ve updated my question. Thanks for the response btw.

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