Pre-existing disease (PED)
What it means, and what it does to a claim.
Any condition you were diagnosed with, or got medical advice or treatment for, in the years before the policy started. Insurers usually look back 36 months, and will not cover it until a waiting period has passed.
Why it matters
This is the single biggest cause of rejected health claims in India, and almost always for the same reason: the condition was not declared on the proposal form. Declaring it does not usually mean refusal — it means a waiting period, a loading, or an exclusion you can see. Not declaring it means the insurer can decline the claim years later, when you need it. Declare everything, including things you consider trivial or long resolved.
The legal definition
Pre-existing disease (PED) means any condition, ailment, injury or disease: a) that is/are diagnosed by a physician not more than 36 months prior to the date of commencement of the policy issued by the insurer; or b) for which medical advice or treatment was recommended by, or received from, a physician, not more than 36 months prior to the date of commencement of the policy.
Quoted verbatim from an IRDAI-filed policy wording. Definitions are standardised across insurers, but the limits attached to them are not — always read your own policy schedule.
Plans where pre-existing disease (ped) matters
- HDFC ERGO Optima Secure+ — No limit — any room category
- SBI General Super Health Platinum Infinite — No limit — any room category
- Care Health Care Supreme — No limit on ₹10 L and above
Related terms
- Disclosure of information norm — The clause stating that the policy is void, and premiums forfeited, if information was misrepresented, mis-described or withheld.
- Material Facts — Anything an insurer would want to know when deciding whether to cover you and on what terms — your medical history, habits, occupation and existing policies.
- Waiting Period — A stretch of time at the start of a policy when certain conditions are not covered yet.
- Specific Waiting Period — A separate waiting period attached to a named list of conditions and procedures.
Disclaimer: Figures shown here are compiled from IRDAI annual reports and public grievance disclosures, and from insurer public disclosures and policy wordings. Claim settlement ratios and complaint volumes are three-year averages for FY 2024–26. Premiums are indicative illustrations for the stated profile, not quotes — your actual premium depends on your age, health, city, habits and underwriting. Scores are Myinsurancebro's own assessment. Always read the official policy document and speak to an advisor before buying. Myinsurancebro is an IRDAI-licensed insurance advisor — we do not manufacture or underwrite any insurance product.