We get asked about pre-existing conditions a lot. Coverage for pre-existing conditions is one of the most sought after elements of a health insurance plan, and something that can distinguish which insurer you will choose to buy a plan from. We want you to have a plan that suits all your needs, so we’ll try and clear up some of the confusion about these conditions and help you to find the right insurer and plan to cover any that you may have.
Pre-existing conditions are a common insurance coverage need now, as more people in recent decades have acquired conditions such as diabetes through increasingly stationary lifestyles. This is compounded by changes in attitudes to diet and exercise, and the advances in medical science which keep people alive who previously may not have been so lucky, but are now burdened with a condition for the remainder of their life.
What is a pre-existing condition?
This is any chronic issue, be it injury or illness, that you had prior to signing up with an insurer but may affect you while you are with your new insurer. They are something that you are likely to need to receive treatment for throughout your life, and include such things as ruptured ligaments, chronic coughs, cancer, and type-II diabetes. Any health problem you had before joining with an insurer counts as a pre-existing condition, whether you were aware that the problem existed or not.
Why is it a problem for insurers, and what are an insurer’s options?
Insurers typically did not accept coverage for a client’s pre-existing conditions in the past. These conditions represent a virtually guaranteed payment for the insurer, as the insurer knows the likelihood of them paying for treatment for your chronic injury or illness at some point is high. This is a problem for you as a client as, for the same reasons insurers don’t want to cover the conditions, you will want to cover them more than anything. Insurers are therefore beginning to accept clients these conditions, which they can then deal with in one of several ways:
Firstly, the insurer can agree to cover your conditions fully, as normal, in accordance with the rest of your insurance plan. If your condition is something minor that is unlikely to be costly to the insurer, you may be offered this option.
Secondly, an insurer can provide you with full coverage, but will do so by loading your premium. Premium loading means that the insurer increases your premium fee, be it by a small annual % or through increasing your monthly fees, to cover the pre-existing condition. You are more likely to receive the option of premium loading to cover pre-existing conditions from a high quality insurer, and it is recommended that once you have been offered a plan by an insurer that includes your pre-existing conditions, you stay with that insurer long-term.
Thirdly, an insurer may offer you coverage for these conditions only after a moratorium period. A moratorium is an amount of time determined between you and your insurer throughout which you must not claim for any treatment for your pre-existing conditions, and will not be covered for any treatment related to them. If you have received no treatment for them during this time, then the insurer will cover you fully from that point onwards. Moratorium periods are typically 2 years, but this differs from case to case.
Fourthly, an insurer may simply opt to exclude your conditions from coverage and only provide treatment for any illness/injury after you have signed your contract with them. This is known as an exclusion plan. Furthermore, the insurer will not cover treatment for other ailments that are related to, or as a result of your pre-existing conditions.
Finally, though this rarely occurs, an insurer may choose to deny your case entirely. This would only occur if they considered your illnesses or injuries too costly for them to cover at all.
A further option that may be available to you is to cover your conditions through an MHD policy. This stands for Medical History Disregarded, and means that an insurer won’t factor your medical history into whether or not they will provide you with coverage. MHD policies are group policies, and as such not available to individuals. They offer individual cover for pre-existing conditions for those of you that are part of the group, as the risk to them of covering your individual condition is minimal compared with the premium costs of the entire group. We can help you set up an MHD policy as part of a corporate or group insurance plan, all you need to do is make an enquiry on our quotes page, or talk to one of our specialists.
When to buy health insurance
We highly recommend that you purchase a good insurance plan before you have any pre-existing conditions if possible. This especially applies to those of who you are seniors, are getting on in years, or are simply accident prone, as with age comes an increased likelihood that you will develop a chronic illness or injury, and you will find it harder to get coverage under a new plan. If you need to buy medical insurance, but already have acquired a condition, then you will have less options for insurance available to you, and will have to find an insurer that will offer you a moratorium period, or any of the options we discussed above.
Transferring to a new insurer
If you are already on a plan, and want to change to a new plan with a new insurer, but have developed conditions that would be considered pre-existing with this new insurer, then we highly recommend taking careful consideration of your options. Switching to a new insurer might seem like a good move for you, but you must factor in how this insurer will treat your existing conditions, as any chronic illnesses or injuries you have picked up whilst with your current insurer will be considered pre-existing on a new plan. We can help you to go through your options and perform a cost/benefit analysis to see whether transferring plans is a good idea for you.
How we can help you
Now that you have a bit more information about how to deal with these conditions, you should have a clearer idea of what you want from your plan, and what it will be possible to get coverage for. If you want to discuss your options further, or are unclear on any aspects of your plan, then contact us and one of our experts will gladly help you to find your perfect plan. We have years of experience in the insurance business, and work with all the top insurers. Using the relationships we’ve garnered, we can help you to find a plan that covers what you want at the price you want. You can fill in our quote form for more in-depth options, or contact one of our experts here and we’ll help you with whatever it is you need.