Illness in Health Insurance

Any illness or disease due to which there is a hindrance in your daily activities and requires medical treatment is termed as an illness according to health insurance. There are mainly two types of illnesses - acute condition and chronic condition.

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• Acute condition: Under acute conditions, there are diseases or injuries that require immediate medical attention. It is a condition that comes to the fore suddenly. If proper treatment is received at the right time, then the person recovers soon from the acute condition and is able to carry out their daily activities again
• Chronic conditions: Chronic conditions are diseases or injuries for which the treatment process goes on for a long time and may require frequent doctor consultations, examinations, checkups and tests. Apart from this, chronic conditions take a long time to gain control over or get relief from. Many times the patient has to adapt their lifestyles to these diseases and undergo a process of rehabilitation. These diseases can re-emerge once they are cured.

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The main benefit of health insurance is to help you avoid a shortage of money at the time of an illness or accident and help you get proper treatment at the earliest possible moment. Diseases are covered in every insurance policy. Some of the types of illness cover in health insurance are as follows:

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Acute Illness Cover: Under this, every common disease due to which you can get infected in the future is covered. Coverage for such diseases usually starts after 30 days of taking health insurance. If you take myUpchar Bima Plus health insurance plan, then you get the facility of free online consultation from day one along with acute illness after 30 days.

Chronic or Critical Illness Cover: Serious diseases that affect a person for a long time come under this category. Many such diseases get covered under health insurance if you renew the policy continuously for 2 years or 4 years without any lapse. There are some critical illnesses for which you can also buy a separate policy. Such a policy is called a critical illness policy and the company transfers your chosen sum insured amount to your account as soon as the disease is diagnosed.

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Pre-Existing Illness Cover: Under this category come diseases that you have suffered and are undergoing treatment for during the 48 months before taking the insurance. At the time of buying an insurance policy, when you mention that you have such a disease, the company can give you a waiting period of up to 24-48 months for the same. That is, your health insurance company can cover such illness but after the specified period of time. Sometimes the insurance company may deny you health insurance because of a pre-existing illness, while other times you may be charged an additional premium to cover that illness along with a waiting period.

There is another type of illness cover, but it is not covered under your normal health insurance. This illness cover is given as a separate policy for a specific disease. Under it, coverage is available for only that disease or organ. For example cancer care or eye care insurance policies.

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You can buy your policy from any health insurance company. Every policy has a waiting period to cover different diseases. Simple diseases also come in this waiting period. Generally, when you buy a policy, emergencies like accidents are covered from day one. But for the treatment of any other disease, you have to wait at least 30 days. There may be a waiting period of 24 months to 48 months for critical illnesses and pre-existing conditions.

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For example, suppose Rahul lives and works in Delhi. He has recently taken an individual health insurance policy. He falls ill within 15 days of taking this policy. If he goes to the nearest hospital for treatment and makes a claim, then the claim will not be given, as his policy had a waiting period of 30 days. Now, suppose that Rahul falls ill after one and a half months and has to be hospitalized for a few days, then the insurance company will give the claim after necessary investigation.

Any one illness means a person suffering from one disease continuously. Generally, relapse of any disease within 45 days also comes under the category of 'any one illness'.

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