If I have a chronic ailment (diabetes, BP, thyroid, heart cond ition, etc.) can I still get coverage? Should I inform the insurer? What if I hide this information from the policy issuer?

Ans:

Yes. If you have any major health ailments in India -- whether it's Thyroid, BP or Diabetes -- you can still avail of your hospital and medical expenses. There are policies available for patients with the common complications of prevalent conditions like diabetes and thyroid. There is health insurance coverage accessible for everyone, but make sure you notify your insurance provider of any illnesses and understand your policy's coverage.

Thus, when you fill up your proposal form for a health insurance plan, you need to disclose all material facts; else your claim might be rejected on the basis of non-disclosure or misrepresentation of material facts. So, if you have high blood pressure or diabetes, just remember to mention it along with the list of medications prescribed to you. Then, the underwriter will assess your risk and quote the premium accordingly. Also, there could be a waiting period, or, an exclusion attached.

Once the health insurance plan is accepted with the specified risks, all expenses associated with your pre-existing ailment would be covered by your insurer.

Ans: It's essential to be transparent about pre-existing conditions like high blood pressure (BP) when applying for a health insurance policy. While I can't provide a definitive answer without reviewing your policy documents and the specific terms and conditions, here's some guidance:

Review Policy Documents: Take some time to carefully review your health insurance policy documents. Look for any clauses related to non-disclosure of pre-existing conditions at the time of policy issuance.

Contact the Insurer: If you're unsure whether you disclosed your high BP when taking the policy, consider reaching out to the insurance company directly. They can provide clarity on the information provided during the application process.

Grace Period: Since your policy is more than 3 years old and you haven't made any claims, it's possible that any non-disclosure issues may be considered lapsed due to the grace period typically provided by insurers.

Future Claims: In the event that you develop heart-related ailments in the future, the insurance company may investigate whether the non-disclosure of high BP was intentional or unintentional. If it's determined that the non-disclosure didn't affect the underwriting decision or the terms of the policy, your claim may still be honored.

Seek Professional Advice: If you're concerned about the potential impact of non-disclosure on future claims, consider consulting with a legal or insurance expert who can provide personalized guidance based on your specific situation and policy terms.

Ultimately, it's crucial to maintain transparency with your insurer and ensure that all relevant information, including pre-existing conditions, is disclosed at the time of policy application to avoid any complications during claim processing.

Best Regards,

K. Ramalingam, MBA, CFP,

Chief Financial Planner,

www.holisticinvestment.in

Ans: That's a great question! It's fantastic that you've been proactive with your health and maintained good health so far. Let's break down how pre-existing conditions and health insurance claims work:

No Claims and Pre-existing Conditions:

Good news! Having no claims history generally looks good to insurance companies. It shows you've been responsible with your health.
Pre-existing conditions are medical conditions you have before buying health insurance. These might affect your coverage or premiums in the future.
Lifestyle Ailments and Claims:

Lifestyle diseases like BP and diabetes can develop over time. If they go unchecked, they might become pre-existing conditions.
The impact on claims depends on your specific policy and when the condition developed. Some plans have waiting periods for pre-existing conditions. This means you might have to wait a certain time before coverage kicks in for those conditions.
Here's what you can do:

Maintain a Healthy Lifestyle: This is key! Keep up the good work by eating healthy, exercising, and getting regular checkups.
Review your Policy Wording: Look at the section on pre-existing conditions and waiting periods. If unsure, call your NIA customer service for clarification.
Talk to a CFP Professional: A Certified Financial Planner can help you review your health insurance coverage and see if it aligns with your future health needs.
Remember: Early detection and management of lifestyle diseases can make a big difference. Taking care of your health now can benefit you in the long run, both physically and financially.

Best Regards,

K. Ramalingam, MBA, CFP,

Chief Financial Planner,

www.holisticinvestment.in

Ans: When purchasing a mediclaim policy, it is crucial to disclose all relevant health information to your insurance company, including your current medication for cholesterol, even if your levels are within the normal range. Here's why:

1. Transparency and Honesty: Insurance contracts are based on the principle of utmost good faith (uberrima fides). Failing to disclose complete information can be considered a breach of this principle, potentially leading to the rejection of claims.

2. Pre-existing Conditions: Insurance companies often have specific clauses related to pre-existing conditions and waiting periods. Disclosing your medication helps ensure that your policy accurately reflects your health status, and any pre-existing conditions are appropriately considered.

3. Claim Rejection Risk: If you do not disclose your medication and later file a claim related to a heart condition, the insurance company may investigate your medical history. Discovering that you did not disclose your medication could result in claim denial or policy cancellation, especially if it relates to a condition you were aware of but did not mention.

4. Legal and Financial Repercussions: Non-disclosure can lead to legal and financial consequences, including denied claims and possible penalties, leaving you without coverage when you need it most.

5. Customised Coverage: Providing complete health information enables the insurance company to offer a policy that best suits your needs, potentially providing better coverage options or terms specific to your health situation.

To ensure you are fully covered and avoid complications:

• Disclose All Health Information: When applying for the policy, include all relevant details about your health, including medications and doctor's advice.
• Read the Policy Document Carefully: Understand the terms and conditions, especially regarding pre-existing conditions and waiting periods.
• Consult Your Insurance Agent: If you have any doubts or need clarification, consult your insurance agent or a financial advisor to ensure you are fully informed and compliant.

By being transparent about your health status, you can secure your mediclaim policy effectively and avoid potential issues with future claims.