Does Group Health Insurance Cover Pre-existing Illnesses?

One of the best on-the-job benefits that employees look forward to is access to health insurance policies provided by employers. It helps them get medical benefits for any emergencies or accidental injuries. However, one confusion that employees have is whether or not group health insurance covers pre-existing illnesses.

What are Pre-Existing illnesses?

A pre-existing illness is a medical condition that the policyholder was diagnosed with before buying a health insurance policy. The time for these illness symptoms or diagnosis should not be more than 36 months before the commencement of the policy. 

Pre-existing diseases are illnesses that already exist in policyholders. For example, the insured person may suffer from high blood pressure or have a history of cardiac issues. These are all considered pre-existing illnesses for the employee covered under group health insurance. 

Does Group Health Insurance Cover Pre-Existing Illness?

Yes, group health insurance covers pre-existing illnesses. Most companies do provide coverage for pre-existing conditions as part of the base plan. However, if your selected insurance does not cover them, you can get add-on cover as a pre-existing waiver. 

Should Employees Get a Pre-Existing Illness Waiver?

If your employer provides group health insurance that does not cover pre-existing illnesses, it is wise to get a waiver. The pre-existing illness waiver provides wider coverage, avoiding any inconveniences during an emergency. 

For example, if an organisation has more employees over 50 years old, then there is a greater chance of them suffering from pre-existing illnesses. Thus, it would be wise for the employer to get a pre-existing illness waiver if the existing group insurance does not provide it. 

Conditions For Pre-Existing Illness Cover

Waiting Period

Group health insurance has an initial waiting period for all pre-existing diseases. This means that during this period, the insured employee cannot make any claims for their pre-existing illness. This waiting period can range from a few months to a few years, depending on the policy provider’s terms and conditions. 

Post-Waiting Period Coverage

Once the waiting period is over, the group health insurance will start providing coverage for pre-existing diseases. This means that an insured person can claim benefits for their pre-existing health issues. 

Continuous Insurance Cover

If policyholders are covered continuously under group health insurance without any mess or breakage, some insurance companies might also waive the waiting period for pre-existing conditions. 

Group Health Insurance Benefits For Pre-Existing Illness

Here are the benefits of group health insurance for employees’ pre-existing illnesses. 

Automatic Enrolment 

Group health insurance automatically includes employees. It means they get coverage for their pre-existing conditions without buying any individual health coverage. 

Family Cover

Another benefit of group health insurance is that it offers coverage protection to employees' family members and extends pre-existing illness coverage for them, too. 

No Extra Cost

The cost of pre-existing illness is included in the employer's overall group health insurance premium, so employees do not have to pay any extra costs out of their own pockets.  

Ways To Enhance Your Group Health Insurance Benefits

You can enhance your group health insurance coverage and get more benefits by following these tips. 

Know Your Group Insurance

There are various types of group health insurance; it is crucial to know what group insurance your employer chose for employees. Understand all the features, inclusions and exclusions of your policy to get maximum benefits. 

Frequent Health Check-Ups

Health is wealth, and the more you understand it, the more you will be able to avoid diseases. Utilise the preventive health check-up benefits provided by group health insurance to monitor your pre-existing illness. This way, you can take precautionary measures before any issue. 

Document Your Medical Records

If employees have a history of pre-existing illnesses, they need to maintain detailed medical records. As a patient with a pre-existing illness, this will help you make claims easily and process them faster during any emergency. 

Always Stay Informed

Employers provide group health insurance policies to employees, which are renewed annually. As an insured employee, you must be informed about any changes or new negotiations made after the policy renewal. 

At The End

With information on whether or not group health insurance covers pre-existing illnesses, employees can make informed decisions. Although most group health insurance plans do provide pre-existing condition coverage, they do not provide coverage, and employees can get add-on coverage for pre-existing illness waivers.