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What is Pre-existing Health Condition

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I`m going to write about quite an important subject in private health insurance business and impact on health insurance holder. I found that sometimes consultants don`t explain details to their clients causing later unpleasant situations when comes to reimbursement. I also realized that there is still a lot of  confusion about this matter. Insurance consultant must make sure that potential clients are well informed about it. There are a lot of people worldwide living with a pre-existing health condition. It doesn`t mean that they cannot have proper health insurance at all.

What is the pre-existing condition?

A pre-existing medical condition or related medical condition means any disease, illness or injury you had before the date on which your international health insurance plan starts, whether the condition has been diagnosed or not, that has one or more of the following characteristics:
was foreseeable;
clearly showed itself;
you had signs or symptoms of;
you asked for advice about;
you received treatment for;
to the best of your knowledge, you were aware you had.

Do you cover a pre-existing condition?

Pre-existing conditions – generally we do not pay for treatment for any condition that you experienced or had treatment or advice for before the start of your cover with us. Yet, we may pay for such a condition if you have no further treatment, advice, medication, tests or symptoms for that condition in a consecutive 2 year period immediately after the date that your cover starts with us.

Do you cover chronic condition?

Chronic conditions – these are conditions that are not curable and which are generally maintained or managed by ongoing treatment or medication. We don’t pay for the routine maintenance of such conditions, but we may pay for the diagnosis and treatment of new conditions which occur after the start date of your cover with us.We will pay for cancer treatment if it`s diagnosed after your start date with us.

You may apply for Full Medical Underwriting (FMU) to cover all or some of your pre-existing conditions.

You will need to submit a full medical declaration for us to assess.
On the FMU u/w, if pre-existing conditions is declared, the application will be referred to our underwriters who will then tell if any exclusions are to be applied to the policy. The member is then clear from the start of the policy if anything is excluded from cover.

This applies to the majority if not to all private insurers whether they are big or small. For clients, this is the reality they must face it. In rare cases it impacts peoples` decision whether to take a certain insurance provider or not, but believe me, you will have to realize that everywhere is the same about this matter. Besides, it`s not the end, not everyone get the exclusion. As an example, I will use clients with Asthma and Tumor.

Upon receiving FMU form, underwriters excluded Asthma from cover. At the same time when a client received first assessment, there was another document attached called: “MEDICAL QUESTIONNAIRE: RESPIRATORY “ Underwriters requested more information from the client because they assumed that there is a chance to have it removed from Policy Exclusion right at the beginning. Here client full cooperation is appreciated. The final decision was positive and updated Insurance Policy has been issued.

You would like to know the reason behind it. Well, the client had Asthma a while ago and on FMU when asked about asthma she “ticked” box “YES” (see below). This raised attention from underwriters who didn`t know any further details. When they received extral information, the team of professionals found that the client hasn’t had any symptoms for few years and wasn`t under any ongoing medication.

An adult person who had a tumor, which has been treated and healed in the past. When underwriters received more details, the exclusion was not added to his policy either.

Another case with Asthma didn`t have such happy ending. A client who is still at young age gets asthma attacks from time to time. The exclusion was still applied due to ongoing treatment and need to be under medical control. Yet, due to his young age whose body is still developing and growing he may be free of illness in the future, thus, underwriters added to his policy the following statement:

“…We will be happy to consider removal of the asthma exclusion in 24 months, upon receipt at that time, of up-to-date evidence confirming that all issues have resolved and have incurred no further treatment, medication or recurrence of symptoms..”

As you can read from the above examples, not all pre-existing conditions are excluded. It depends on a case by case. The only way that we can fully check any pre-existing condition for cover or exclusion is to receive full information on an FMU application form. The underwriters will then ask for extra information if it`s required.
You will be still insured for all other health problems that might arise in the future. Besides, please take into account 2 years moratorium as mentioned above.

I want to advice you to ask your consultant about the pre-existing condition that you might have now. You have to get explained clear and the way you understand, not just meaning. The adviser must treat you fair. It`s like going to a doctor whom we trust and rely on his skills to help us. It`s about your life, not the numbers !

Please share this story with your friends, colleagues,co-workers. I would be glad to hear your experience in the comment below. Thanks

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