Medical condition diagnosed or treated prior to buying health insurance.
A Pre-Existing Disease (PED) refers to any health condition, ailment, injury, or medical illness (such as Diabetes, Hypertension, Asthma, or Thyroid disorders) that was diagnosed, treated, or for which medical guidance was sought within 48 months prior to purchasing the health insurance policy.
Sanjay was diagnosed with Type-2 Diabetes in 2023. In 2025, he buys a health policy. Diabetes is classified as his Pre-Existing Disease. Claims related to diabetes or its complications will be payable after his policy's 24-month PED waiting period completes in 2027.
A Pre-Existing Disease is covered after a defined waiting period (12-36 months). Non-disclosure of PED during proposal filing can lead to total policy cancellation and claim rejection under non-disclosure rules.
Many policyholders misunderstand this clause until a claim actually occurs. Always verify the exact definitions in your policy wording schedule rather than relying on verbal marketing summaries. Disclose all material facts truthfully at the time of proposal to help ensure smooth claim assessment without non-disclosure issues.
IRDAI guidelines state that after continuous coverage of 36 months (reduced from 48 months), no health insurance claim can be repudiated on grounds of pre-existing disease non-disclosure except in proven cases of gross fraud.
Always disclose complete past medical history, surgeries, and long-term medications during policy proposal filing to ensure 100% claim security.
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