Insurance Coverage of Pre-existing Conditions

A common query we receive is how to approach insurance with a pre-existing medical condition. In fact, about 50 percent of our clients looking for medical insurance come with a pre-existing medical condition. We understand that medical conditions differ, some are minor while others can be difficult to manage and require expensive treatment.

The past twenty years has seen a rise illnesses related to general lifestyle choices, including diet and exercise. Chronic conditions that originate from these lifestyle choices are treatable due to improvements in health care, but may come so at a high cost.

How does it help?

We always advise our clients to cover all pre-existing conditions in their health insurance if they have the option to. A typical health insurance policy will not cover a pre-existing medical condition, nor cover the ‘consequences thereof’ of the same condition. 

Because pre-existing conditions span an extensive spectrum, it is essential to incorporate cause and effect. For example, a doctor examining a person with high blood pressure (Hypertension) who has suffered a heart attack will likely confirm the Hypertension as a contributing factor. The health insurance by default would no longer cover the heart attack.

Because of this relationship between pre-existing conditions and current health state we advise that any insurance plan you choose includes all pre-existing conditions. This is particularly relevant if conditions are or could be related to cases of high cholesterol, high blood pressure or diabetes.

What is a pre-existing condition?

If you have a pre-existing medical condition, it will be any medical condition that you already have been treated for or have been made aware of. This also includes everything you suspect to having, as well as anything that you could reasonably be expected to know (obvious symptoms). When making an application for an insurance policy this information must be presented before any decision can be made.

An example: if you applied for health insurance and were unknowingly suffering from early stage cancer, (and as long as you were not aware of this) the insurer would cover your condition (as it cannot be classified as pre-existing). It is generally advisable to carry out health checks after purchasing health insurance, as health issues discovered beforehand would be defined as pre-existing and therefore exempt from coverage.

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Which conditions can be covered?

With pre-existing medical conditions more common today, many such as Hypertension, High Cholesterol, Asthma, Skin Cancer (BCC) are now being introduced under health care coverage. A client’s case history will need to be reviewed, including an accounting for health and lifestyle issues. After the review the condition can be covered in full, but subject to a premium loading; this is a percentage of the annual premium, and can either be quite small or relatively expensive depending on the severity of the condition.

Insurers have also started covering serious conditions such as Cancer, Heart Attacks and Diabetes. Of course, the decision will always be at the insurer’s discretion and on a case by case basis. Many insurers require a certain length of time to pass after the latest effect of a condition and will only consider coverage after a suitable period of time has passed. In cases involving conditions such as Cancer, this time period can be about five years. Type II diabetes is a pre-existing condition that insurers typically cover, and it is relatively common to offer it to patients who have developed the condition later in life. The range of conditions that can now be covered is broadening, along with the number of insurers willing to extend coverage for such conditions.More insurers today are prepared to cover pre-existing conditions, but clients are also required to pay a higher premium due to the increased risk.

After your pre-existing conditions have been incorporated into your cover, your health insurance plan will continue as normal where claims can be submitted and settled according to policy limits.
 

Application evaluation

Before you can be accepted on to a health insurance plan, an insurer will evaluate your case through an  'underwriting' process. This process normally requires you to submit recent medical records, or to undergo  health tests to comprehensively evaluate your overall condition. This usually results with one of the following proposals:

• To cover you as a normal case with no loading or exclusions

• To cover your pre-existing conditions with a premium loading

• To cover your condition after a further moratorium period (additional waiting period)

• To provide coverage for you but exclude your condition  

• To decline the case

Cases are rarely declined outright and completely, but complicated conditions (particularly if there are multiple illnesses), make it difficult for the insurer to fully assess the risk of covering you.

The likelihood of contracting a lifestyle illness or chronic condition increases as we age, so it’s advisable to be prepared with health insurance before waiting for a serious condition to develop.

Does quality count?

A quality insurance plan will ensure that your pre-existing conditions are covered for the foreseeable future, providing long term stability. We do our best to suit our client’s needs at the first appointment of insurance, as changing insurers is generally advised against.. We make sure to be careful with the considerations and analysis of the policy and it’s benefits so you can stay with an insurer who is committed to maintaining long term health insurance. There may be cause to switch insurance providers,  if for example premiums were to rise sharply or if benefits were to be diminished. Should this happen, we would seek out another quality insurer willing to offer a better service. 

MHD (Medical History Disregarded) Policies

In some cases, group health insurance organised by your company will  include policies that can be arranged on an MHD basis.Through an MHD policy, all pre-existing conditions are covered without the need for an underwriting process. Generally, we find that MHD policies are only offered to large groups. If you are unable to find a suitable policy to cover a pre-existing condition as an individual, one reliable way to acquire insurance is to join a corporate scheme equipped with MHD features. This becomes possible only because the relatively high risk of insuring one individual’s pre-existing condition is mitigated, due to the increased size of the group. Arranging such a corporate health insurance plan is best done with specialist advice to ensure the necessary benefits are featured and the correct details are in order.

Now what?

The best way to manage a pre-existing health condition by arranging medical insurance is to seek somebody that understands the process fully. Finding the right insurer, and then finding the right plan to suit your specific needs is where we come in. This may involve submitting up to 5 or 6 applications for insurers to evaluate, to ensure you are aware of the various proposals available. Presenting you with multiple policies and options, we will discuss an application in depth with you before finding a solution you are happy with.

The application for pre-existing conditions on a policy can seem overwhelming, but we make sure the process is manageable from start to finish.

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