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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Questions and Answers from Visitors

  1. sherry:

    My mother, 72 years old, have blood pressure and blood sugar problem. we are going to invite her to US for visiting several months. Could we buy her medical insurance here? How much usually is it for that?


    1. Bosco:

      Since you only require cover for a short period of time, I would suggest you look into Travel Medical Insurance and you can buy this insurance from us. It can cover both Inpatient and Outpatient treatment. As well as cover for emergency evacuation and repatriation. The premium is calculated according to age and specific dates for which your mother require coverage. You can let us know the details and we can then research the best options from all our providers that best fit your needs.



  2. Kunle Giwa:

    My name is Kunle Giwa. Are there any medical insurance plans with will cover me if I am expecting a baby in 7 months? I am planning to travel to the US for the delivery


    1. Stephen:

      All insurance companies have waiting period for maternity benefits on their plans, it ranges from 10 to 12 months in general. If you are already pregnant prior to joining a plan, then insurance companies will not cover the cost of maternity. Fortunately, we still have some options which will allow an already pregnant woman to join a plan and will not underwrite your newborn. I will be happy to provide you with more details if you wish to learn more.


  3. Gerwin:

    I want to take up an offer to work in Italy for 2-3 years after which I will return to the Netherlands (I'm Dutch). I need a health care plan that covers this period and provide cover for a heart transplantation I had 11 years ago. I need to take daily medication (anti rejection) and a visit to the cardiologist twice a year.

    I am currently insured in the Netherlands however they don't provide cover if I move to Italy and work there too.

    Kind regards
    G van Maanen


    1. Wouter:

      Hi Gerwin,

      We work with several insurance companies that will consider covering pre-existing conditions with a loading in the premium. It depends on the severity of the actual condition(s) how high the loading will be. However, we cannot guarantee cover for pre-existing conditions, insurers have the right to decline persons in general or exclude certain conditions or body parts.
      Another option would be a moratorium plan, a moratorium refers to a period of 1 or 2 years, in this period there is no cover for pre-existing condition(s). If no symptoms will occur in this period, the insurance company will consider covering the pre-existing condition(s).
      In order to find out if an insurance company will cover your pre-existing condition(s), we suggest to fill in an application form from one of the suggested insurers by one of our consultants. The more information you can provide in regards to the pre-existing condition(s), the better the position of an insurance company will be to evaluate the case. They will come back to us within 5-10 working days with the terms of cover and if they will cover the condition yes or no.


  4. Gerwin:

    I am a 41 year old Dutch guy, looking for a health insurance that covers a pre-existing condition. I had a heart transplant 11 years go. Never had any setbacks and only take anti rejection medication and see the cardiologist twice a year.
    I have the opportunity to go work and live in Italy (Rome) to work for a engineering company, it would be for 2 to 3 years.
    I have health insurance here in the Netherlands, however they won't provide coverage if you don't work in the Netherlands.

    I could accept a health care provider who would add a fee, but not an exclusion.

    What are my changes?