Pre-Existing Disease Coverage: Waiting Periods, Disclosures, and Claims
Updated: December 10, 2025•7 min read•By MK INSURE Advisors
Pre-existing diseases (PED) are conditions diagnosed before buying a policy. Insurers cover PED, but only after a waiting period - typically 3 years. Misunderstanding this is the most common cause of claim rejection.
Key PED Rules You Must Know
- Disclosure is mandatory: Declare every condition and ongoing medication.
- Waiting period: Most retail health plans have a 3-year PED wait. Some offer buyback to reduce it.
- Related claims: Claims linked to the PED are denied during the waiting period.
- Continuity: Porting to another insurer preserves completed waiting periods.
How Waiting Periods Work
Initial
30 days (accidents covered)
PED
3 years for declared conditions
Specific Diseases
2 years for cataract, hernia, etc.
Buying with PED? Follow This Checklist
- ✓ Disclose diagnosis, medication, and tests from the last 5 years.
- ✓ Choose plans with 3-year (not 4-year) PED waiting periods.
- ✓ Add consumables and room-rent waiver to avoid proportionate deduction.
- ✓ If already insured, port to preserve completed waiting periods.
- ✓ Consider PED buyback riders to cut waiting to 1-2 years.
Filing a PED-Related Claim
- Notify insurer within 24 hours of hospitalization.
- Submit doctor prescriptions showing ongoing treatment history.
- Attach investigation reports to prove stability of condition.
- Keep discharge summary, bills, and IDs error-free.
- Escalate to Ombudsman if rejected despite waiting completion.
Need help with PED or disclosures?
Our advisors will shortlist plans with the shortest PED waiting, handle disclosures correctly, and support claims.