Are you planning to purchase a health insurance plan but unsure of the different health insurance terms and what they mean? This article gives a comprehensive guide on a particular health insurance term - pre-existing conditions.
A pre-existing condition is a medical condition, illness or injury for which you had symptoms or were diagnosed before starting on your new health insurance plan. Whether you sought treatment for this condition or not, it will be considered “pre-existing” by your insurer.
When applying for an insurance policy, you will need to disclose your full medical history. Your pre-existing conditions will be determined at that stage.
When you are applying for a health insurance policy for the first time, your insurer will ask you to fill in a medical questionnaire and declare any medical conditions you currently have or have had in the past. The questions can be related to relatively minor health conditions (fractures, skin problems, allergies…) to more major ones (cancer, diabetes, cardiac diseases…).
Your insurer will then review your application and assess the risk of insuring you based on your medical history – this is called medical underwriting. They will determine your annual premium as well as your underwriting terms (whether they will offer you a standard coverage or add exclusions, for instance).
Here are a few examples of conditions that may be considered as pre-existing by your insurer:
Chronic pain such as back pain, neck pain…
Cardiovascular conditions such as hypertension, high cholesterol...
Congenital or hereditary conditions
Respiratory conditions such as asthma, allergies…
Mental health disorders such as anxiety, depression…
Previous sports injuries
Each insurer is different, so their underwriting process may vary. Some may ask you to divulge your medical conditions for a fixed period, like 5 years for instance. Some others may require you to disclose your medical history from birth.
Make sure you double-check with your insurance advisor to declare the right information during your application. If you are unsure of whether you need to declare a condition or not, we would always recommend disclosing it, as hiding a pre-existing condition can be strictly penalised.
All insurers have different ways of assessing risks when it comes to your medical history, but here are the most common underwriting outcomes:
Minor conditions, such as bone fractures or infections, for instance, are often accepted as standard as they are not likely to impact your health in the future. This means that they won’t impact your premium nor be excluded from your policy.
Some conditions that present a relatively low risk for you but may still require treatment can be covered by insurers with a loading. This means that you would benefit from a standard coverage, with your pre-existing condition covered as usual, but a loading will be applied to your insurance premium to cover the potential cost of treatment related to this condition.
If you are suffering from a chronic disease or condition that requires a long-term treatment, it is quite likely that this condition will be excluded from your coverage. Your insurer may offer to provide you coverage with a standard premium, but any medical expenses related to this condition will not be covered by your plan.
A great majority of health insurance providers will decline your application if you are suffering from a high-risk condition such as cancer, autoimmune disease or Type 2 diabetes, for instance. In such cases, the risk of covering is simply too high for insurers.
There are two common ways to get your pre-existing conditions covered:
Moratorium is a simplified underwriting method where the insurer can offer to cover your pre-existing condition if you are symptoms free from this condition after a fixed period. The waiting period is usually 2 years, so if you haven’t had any symptoms during that time, you could be fully covered at the end of the period.
However, some major pre-existing conditions may still be excluded under moratorium (such as cancer, hypertension, thyroid disease…), so this solution works best for minor health conditions.
For large corporates, insurers can offer an underwriting method called “Medical History Disregarded”. This means that instead of looking at each employee’s medical history, they will offer standard coverage to all employees covered under the plan, and therefore cover their pre-existing conditions, whether they are minor or major.
When disclosing your medical history, you need to be as transparent as possible and declare any conditions you had signs, symptoms or been have diagnosed with. If you fail to disclose your medical history, and your insurer discovers a pre-existing condition while investigating a claim, they may take the following measures:
Your claim may be declined, and an exclusion may be applied to your policy, meaning all future claims related to the same condition will also be declined. In some cases, you may also be asked to reimburse previous claims paid by your insurer if they are related to the same condition.
Your policy may be cancelled immediately, leaving you with no coverage. If claims have been paid by your insurer, you may also be required to pay them back.
You can also learn more about our international health plans for SMEs in Asia or visit our dedicated pages to find out more information about our plans for individuals and families.
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