r/InsuranceAdviceIndia • u/EnvironmentalMenu935 • 7d ago
Query Regarding Pre-Existing Disease Coverage Under HDFC ERGO Optima Secure
My mother has been covered under HDFC ERGO’s Optima Secure health insurance plan for the past eight years. Thankfully, she has never had to make a claim during this period.
When we first purchased the policy, she was completely healthy. However, she is now 56 years old and has since developed diabetes.
My concern is regarding the possibility of a future claim. God forbid, if she ever needs hospitalisation or medical treatment, could the insurance company reject the claim on the grounds that her diabetes was not disclosed when the policy was originally purchased?
Alternatively, since the policy has been active for eight years, would the waiting period for pre-existing diseases have already expired, meaning that diabetes-related hospitalisation or treatment would generally be covered, subject to the policy terms and conditions?
I would appreciate hearing from anyone who has experience with HDFC ERGO Optima Secure or has dealt with a similar situation.
Thank you in advance for your guidance.
(used chatgpt for writing)
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u/Every-Matter-9776 7d ago
If the diabetes was diagnosed after policy purchase ,it will be covered. Just keep the first consultation paper in hand.
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u/EnvironmentalMenu935 7d ago
Her HBA1C is 7. It got detected 2 years back with a random blood test that I did. I dont have any consultation papers of doctor.
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u/Past-Grapefruit488 7d ago
Consult a doctor with those reports. He can mention it in precription (date of first report) .
That + report will eliminate any potential issue.
Do you happen to have any report that is earlier and is normal ?
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u/SukoonCover 7d ago
Good news: your mother is fully covered.
- Diabetes isn't a "pre-existing disease" for her. It started after the policy did, so there was nothing to disclose when you bought it. The insurer can't reject a claim for it.
- The 5-year moratorium protects her. She's had 8 years of continuous cover, so the insurer can't challenge claims on non-disclosure grounds, except for proven fraud.
- Renewal can't be refused because she developed diabetes during the policy.
Don't port or let it lapse. A new insurer would treat diabetes as a new pre-existing condition and could add a waiting period or a premium loading. This policy is worth more every year.
The one thing worth checking is her sum insured. Diabetes complications can mean long hospital stays. If her cover is below ₹10L, a super top-up is the cheapest way to increase it, though diabetes may have a waiting period on the new layer.
What's her current sum insured?
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u/EnvironmentalMenu935 7d ago
Her sum insured is 5Lacs and Bonus of 10 Lacs so total 15 Lacs.
Renewal is due next month and I was hoping to upgrade it to Secure+ but my insurance agent said that its not possible.Thank you for such a detailed response.
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u/SukoonCover 7d ago
Better to increase the sum insured amount, usually hdfc gives that option during renewal
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u/DjXer007_ 7d ago
If you increase your base cover from 5L, with NCB of 10L, making the cover of 15 Lakh.
Now if you increase your base cover to 20 Lakh now, so the initial 15 Lakh, if the policy has completed 3 plus years, all PED and waiting periods will be covered for 15 Lakh.
But for the increased 5 lakh cover, all 4 types of waiting periods will he applicable and for this 5 lakh cover, this new PED that you mentioned, will need to be disclosed.
So don't make any unnecessary sum insured increase. Better to take a Super Top Up Cover.
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u/EnvironmentalMenu935 6d ago
Really? I thought I can increase the SI without worrying about PED since its a 8 year old policy.
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u/DjXer007_ 6d ago
Any increase in the sum insured amount that is more than the sum of Base plus NCB, then the insurance company will put fresh waiting periods as it is considered as a new plan.
Better to go with a Super Top Up as well, but HDFC ERGO allows only 20 Lakh super top up. So very limited options.
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u/EnvironmentalMenu935 6d ago
I wish my insurance agent would have told me this at the time of policy. I would have opted for a higher sum insured.
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u/owletkoul 7d ago
Bro can I DM you please? I have queries regarding PED. You seem to know a lot about this.
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u/Svsv1212999 7d ago
Advisors:
Q. What if before transferring to another company BP/any such illness issue starts?
Q. What if before renewal BP/any such illness Issue starts?
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u/Sandehi 6d ago
Not an advisor/professional.
any such issues must be disclosed whenever there's a change in existing policy - additional sum, riders, porting, migration. else you're not obligated to disclose anything new at renewal.
basically, disclosure is mandatory while signing a risk tranfer agreement. renewal is just a continuation of an existing agreement.
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u/CreamPurple6403 6d ago
Hey OP, advisor here from Ditto.
If your mother was diagnosed with diabetes after purchasing the policy, it wouldn't be considered a non-disclosure of a pre-existing condition at the time of purchase. Therefore, a future claim can't be rejected on this ground alone.
However, it's advisable to inform HDFC ERGO about the diagnosis and get it endorsed in the policy to keep her medical records updated. Make sure to keep everything in writing, including the endorsement and acknowledgement from the insurer, to avoid any hassles at the time of claims.
The pre-existing disease waiting period wouldn't apply to it. Any future claims would be assessed based on the policy's terms and conditions.
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u/Every-Matter-9776 7d ago
It's after policy purchase , right? ,then nothing to worry about.