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Group Health Insurance

Does Group Insurance Cover Pre-Existing Conditions?

By December 1, 2021December 16th, 2021No Comments
Does Group Insurance Cover Pre Existing Conditions 1

Yes, group health insurance will cover pre-existing conditions. This is a common misconception that people have when they are getting ready to sign up for a plan. Many think that their medical history can keep them from being covered by an insurance company or group health insurance provider. This is not the case, however, most plans will require an additional monthly fee for those with pre-existing conditions.

If you have a medical condition and are trying to get insured under a group health plan, you must talk to your insurer about what is covered and any extra fees that may be associated with getting coverage if you already have a pre-existing condition. If the plan will cover the preexisting conditions they may request proof of treatment or certain documentation. Finding the right type of health insurance can be a difficult and stressful task. It is especially difficult for employed individuals who need to provide for themselves and their family, but also want to grow their business. 

What is classed as a pre existing medical condition for health insurance?

A pre-existing condition (PED) is a medical condition or injury that existed before the effective date of an individual’s health, dental, or disability insurance policy. It usually refers to conditions that require ongoing medical treatment and management for a disease process known to exist before the inception of the new coverage plan. Health insurers consider such conditions as extremely high risk and will either refuse to issue coverage or charge significantly higher premiums for such conditions.

As per the latest guideline on standardisation of health insurance terms, IRDAI has set new guidelines to define pre-existing diseases ( PED). As per the guidelines, any disease/s or ailment/s that is/are diagnosed 48 months prior to the issuance of the first health insurance cover will now be classified under PED. Moreover, any disease/s or ailment/s for which any type of medical advice or treatment was recommended or received by a qualified doctor 48 months prior to the issuance of the policy will also qualify under PED. Any other condition whose symptoms or signs have resulted in a serious disease within three months of the issuance of the policy will also be classified under Pre-existing Diseases. *

Typically, once individuals pass an initial waiting period (typically between three and six months), they are covered under their new plan without any exclusions for such pre-existing conditions. However, some insurers refuse to cover pre-existing conditions after the initial waiting period. This will be applicable for individual health insurance policies, and often gets covered or included in group health insurance plans. 

Insurance companies can also choose not to renew your health insurance policy if they find out that you have a pre-existing condition while your policy is in effect. If this happens, you will be given notice before your plan expires and may be offered another plan by the company (with higher premiums) or by another carrier. 

A term known as “Pre-Existing Condition” usually relates to an ailment the worker had before entering into a contract with the employer. Therefore, when you join a group insurance plan offered by your company or organization, it may not cover any injury or sickness that was present at the time of application for the insurance policy. Likewise, some policies may even go so far as to not cover any conditions you had at some point in the past.

What Pre Existing Conditions are Covered in Group Health Insurance?

The common diseases covered are :

  • High blood pressure
  • Diabetes
  • High cholesterol
  • asthma

Additional information on Group Health Insurance 

Group health insurance is a type of plan that offers benefits to a large number of people who are working in a single organization or under the same roof. These groups include employers, universities, school districts, churches, and unions. This system works when an employer selects an insurance company from whom they will purchase policies for their company. The insurer then negotiates a contract with business owners in order to provide benefits packages tailored specifically for their needs. In return for the premiums paid by the employer, the insurer helps pay for the medical expenses of eligible employees.

Advantages of Group Health Insurance

The cost of health insurance can be extremely high for private, individual policies. If an employer purchases a plan instead of their employees purchasing one themselves, they save money on taxes and give their workers more benefits than they would get on their own. If the employer chooses to cover only part of the coverage, then some employees may prefer to purchase a personal policy that gives them full benefits. Whatever option an employee selects, group health insurance is beneficial to all parties involved because it provides more protection at a lower price.

Contrary to popular belief, group health insurance does not prevent people from taking out additional personal policies with other companies to help pay medical bills outside the scope of their primary plan. Some types of coverage like dental will not be eligible under the primary policy anyway. A separate plan for this would certainly be more costly than an individual policy that does not cover these expenses.

Group health insurance is especially advantageous for small businesses who want to offer benefits packages to their employees without having to pay for them alone. A company can pool its resources with other organizations to negotiate better rates and more competitive plans with insurers. They also save on administrative costs by allowing the insurer or broker to handle all of their paperwork and claims processing through one point of contact. 

Conclusion

With pre-existing conditions, the best way to find out is by calling and taking unbiased advice from professional insurance brokers. PlanCover.com has been at the forefront in helping individuals and businesses with a tailor-made health insurance plan that includes pre-existing diseases ( PED).  Nowadays, certain rules prevent insurers from denying coverage for people with previous medical issues or higher risk factors like obesity and tobacco use. However, if you are currently sick then it’s likely that your plan will not cover any treatments related to this illness until you’ve been covered under a group policy for 12 months. 

* https://www.irdai.gov.in/ADMINCMS/cms/Uploadedfiles/RTI_FAQ/FAQ_RTI_HEALTH_DEPT.pdf

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