Pre-Existing Conditions Health Insurance Cover

One of the most confusing parts of health insurance policies is the pre-existing condition section. Sometimes people are unsure exactly what a pre-existing condition is or why they are not usually covered by insurers. Hopefully we can explain all that to you here.

Around half of those who want to buy medical insurance have a pre-existing condition. It could be something such as a minor condition that has little or no impact on your daily life. Alternatively it could be a serious condition such as type II diabetes or a heart problem. These are the conditions that will need ongoing treatment.

There has been an increase in the number of people who have a pre-existing condition that want health insurance coverage. For many people life is much more sedentary than it used to be and there is a whole range of health conditions that are connected to lifestyle and diet. The progress made with medical treatments also mean that there are more people living with ongoing health conditions than there used to be, leading them to be classed by insurers as having pre-existing conditions.

However, this does not mean that it can be difficult to get health insurance with a pre-existing condition. There is an increasing number of health insurance providers who are now willing to consider those who have pre-existing conditions, due in part to the advances in medical science that can make the conditions much more manageable.

What Are Pre-Existing Conditions?

A condition categorized as ‘pre-existing’ is one that you have been treated for previously, or one that you have already shown symptoms of. It can be considered a pre-existing condition even if you did not know that you had it before you applied for the health insurance. It could be an injury like a torn ligament or an ongoing respiratory problem. Hereditary conditions such as diabetes can also be a problem. For insurers these conditions can be a problem as they do not want to offer insurance knowing that there are guaranteed bills to be paid, but clients want help for these problems more than others.

What Are an Insurer’s Options When Taking on a New Client With a Pre-Existing Condition?

The insurer will begin by looking at the client’s medical records and it may be necessary to have some health checks so that your condition can be accurately assessed. Once the results are in there are a number of options open to the provider:

  • You could be given health cover as normal to include any pre-existing conditions that you have. This would be without any exclusions on your policy or any premium loading, something that may be applied if the condition is considered to be minor.
  • You could be given health cover that includes the pre-existing conditions but with premium loading applied.
  • You could be given cover for the pre-existing conditions but the insurer may apply a moratorium period.
  • They could provide you with limited health cover that would not include any condition classed as pre-existing condition.
  • They could decline to give you any health cover at all. This is a rare case and this would normally only be applied to those who had a lot of illnesses or conditions that could prove to be very expensive to insure.

It used to be traditional for insurers to refuse to cover any pre-existing conditions because they knew that they would always have to pay out for treatment. Remember that insurance is actually a risk injury and with healthcare cover you are moving the risk from yourself to the insurer, so it would not be you that is paying for the treatment. There is actually no risk involved with a pre-existing condition as there would almost certainly be a bill for treatment at some point.

This is why exclusion plans have been common, as the insurer will cover any health issues apart from those that you already have. If you have an exclusion plan you also need to be aware that any related conditions will be excluded. For example, if you have been previously diagnosed with asthma, any condition you contract that is connected to it will also be excluded.

As you get older you are more likely to have conditions that are connected to your lifestyle as well as chronic conditions, so it is a good idea to have health insurance in place before you contract any conditions. Full coverage could be denied to you if you wait until you have been diagnosed. However, things are changing in the industry and more insurers are prepared to consider pre-existing conditions.

There has been an increase in the number of people interested in taking out a policy that includes a pre-existing health condition which means that insurers are rethinking their policies. More are prepared to cover some pre-existing conditions including some of the most common ones such as high blood pressure, high cholesterol, skin cancer and asthma. The number of conditions that they will cover is rising and more and more insurers have options for pre-existing conditions.

Some of the top insurers are also prepared to offer various standards of cover for some of the more serious conditions such as diabetes, heart attacks and other forms of cancer. Each case is assessed individually and the amount of cover offered will vary from person to person. The insurer will look at how long it has been since your last ‘episode’ connected to your condition and they will also look at your overall health and your lifestyle to see if these are related factors that could be a problem in the future. Type II diabetes is a condition that is often covered now, particularly when it has been developed later in life.