Understanding Pre-existing Conditions and Waiting Periods for Senior Health Plans

When senior citizens enrol in a new health insurance plan after retirement, a major concern is whether and how that plan will cover any pre-existing medical issues they may have. Pre-existing diseases are health conditions already diagnosed or treated before signing up for a policy. The rules around covering pre-existing illnesses and associated waiting periods can be confusing, especially for senior health plans. In this article, we’ll discuss the pre-existing conditions and waiting periods for senior health plans in India.

What Conditions are Pre-existing?

Insurers consider any injury, disability or illness detected through medical advice, tests, medication or treatment before purchasing an insurance policy as a pre-existing disease (PED).

Typically, diagnoses confirmed up to 2 to 5 years before applying for coverage get classified as pre-existing, depending on the insurer. Some even include health issues you were aware of but didn’t consult a doctor about. Read policy documents carefully to understand defined time limits for PED declaration.

Government Health Schemes and Pre-Existing Diseases

Government health schemes like the Pradhan Mantri Jan Arogya Yojana (PMJAY), Central Government Health Scheme (CGHS) and Employee State Insurance Corporation (ESIC) cannot outright reject your application because of pre-existing diseases in most cases. This provision guarantees health coverage access for all eligible Indian citizens regardless of medical history.

Each Indian state defines these conditions separately, mainly covering acute inpatient care. Outpatient management for pre-existing chronic illnesses is largely covered without restrictions. State government schemes may have some variations, too.

When moving from an employer health policy to a government scheme, ensure proper documentation of earlier diagnoses for continuity of treatment. Also, understand applicable sub-limits, packages and exclusion criteria before buying any health insurance for family.

Private Medical Insurance and Pre-Existing Illnesses in India

Private health plans have more leeway to exclude pre-existing conditions from coverage permanently, impose initial waiting periods before covering them, include sub-limits on claim amounts, or charge higher premiums from seniors with such diseases. Each medical insurance for senior citizens provider defines its own medical underwriting guidelines.

Insurers typically consider conditions detected in the past 2 to 4 years before purchasing the policy to be pre-existing. Their coverage after the waiting period also varies – some pay only up to certain limits, while others exclude related complications forever. Hence, it is wise to compare policies thoroughly.

Portability without fresh underwriting is possible if transferring from an equivalent or superior plan with no coverage gaps exceeding 30 days. This maintains the continuity of agreed benefits.

Research Well Before Choosing

While opting for retirement health plans, the best approach is to gather complete information on how each insurer defines pre-existing illnesses, applicable sub-limits, loading criteria and waiting periods. Disclose all medical history from at least the past 4 years to avoid future disputes. If one company offers limited coverage, check alternatives to find a better match as per the existing health profile and budget.

Why Choose Health Insurance Plans for Family from ACKO

ACKO family insurance plans offer cashless hospitalisation across India plus zero deductions on claims. Leveraging technology, ACKO provides comprehensive, budget-friendly coverage for all domestic medical needs – from hospital stays to full claim amounts.


Various senior citizen health schemes are available in India – both government and private. With diligent research on policy documents, senior citizens can find plans that adequately meet healthcare needs related to pre-existing medical conditions. Seeking guidance from advisors can further help in navigating the insurance market.