Securing Your Health: Navigating Pre-existing Conditions with Private Medical Insurance

If you’re in the process of looking at your private health insurance options, chances are the term 'pre-existing conditions’ has come up and you might be worrying about what it means for you. Pre-existing conditions are an important factor when it comes to medical insurance and the choices you have.

In this post we break down what exactly is meant by a pre-existing condition, why declaring them is important, and the effect these might have on your health insurance cover.

If you have private medical insurance, you pay a monthly fee that covers some, or all of the cost of treatment and medication for any new conditions that occur after you take out the policy. Depending on the level of cover you choose, you may be able to specify where you receive treatment, access outpatient care, cancer care, and additional benefits such as dental care and physiotherapy.

A pre-existing condition is a physical or mental illness, injury or disease that you’ve been diagnosed with or received treatment, medication or advice for in the past, prior to taking out your insurance cover. The definition of a pre-existing condition extends to chronic conditions such as diabetes and long-term conditions such as cancer.

Let’s break down what a pre-existing condition may look like:

●      Diabetes

●      Asthma

●      Hypertension

●      Arthritis

●      Respiratory diseases

●      Crohn's Disease

●      Cystic fibrosis

●      Heart disease

●      Chronic back pain

●      Chronic joint problems

●      Anxiety and depression

●      Allergies

●      Cancer

●      Any other chronic diseases

●      Incurable diseases

●      Injuries that occurred prior to taking out PMI

Failing to declare a pre-existing condition could invalidate your insurance, meaning you will not be successful if you make a claim. Every insurer has their own terms and conditions and assesses your risk on a case-by-case basis, so it is important that you provide the necessary information to do this. If you want to protect yourself from the cost of receiving private medical care in the future, it’s important that you apply for private health insurance when in good health, so that any condition that may occur later is not pre-existing.

Private medical insurance is designed to be a cost effective way for you to manage any treatment or medical care you may need for the duration of your policy. Insurers know that covering pre-existing conditions as standard is expensive, involving long term care, sometimes indefinitely. This would come at great expense meaning they could not offer you an insurance premium at the rate they can currently.

Excluding pre-existing conditions from standard cover means private medical insurance remains affordable to you. Private medical insurance exists to give you peace of mind that you’ll receive the best care should you need treatment in the future, rather than for paying for existing medical bills.

Contrary to what some people think, you can still access private medical insurance with a pre-existing condition. However, in most cases it is unlikely you will get cover for your pre-existing condition, and insurers will simply exclude it from your policy.

Some insurance companies may allow your pre-existing condition if you have been free of symptoms for a certain amount of years, but usually as an extra on your premium. However, this will vary depending on the company you choose so you must do your research to find the best option for you.

When working out the risk of insuring you, insurance companies use underwriting. You’ll find two types of underwriting that vary in how they handle pre-existing conditions. You may find one more favorable than the other.

With full medical underwriting you’ll know from the outset whether your insurance provider includes pre-existing medical conditions in your policy. Using this option, requires you to complete a full medical questionnaire and the insurance company may also speak to your doctor. This way, any pre-existing conditions remain outlined from the start and your insurer decides the risk of covering you and consequently what they are able to include in your policy.

Full medical underwriting often makes claiming for treatment quicker as your insurance company has all your medical information at hand and there is no dispute over what is covered and what isn’t, as it’s all clearly stated in the policy.

Unlike full medical underwriting, if you choose moratorium underwriting, your insurer does not ask for your medical history. However, your insurer can access your medical records when assessing a claim and if they find that your claim relates to a condition noted in your records, they may reject it as a pre-existing condition. With this type of underwriting, if your claim relates to a pre-existing condition that you haven’t had symptoms of or received treatment, medication or advice for in over two years, your insurer may allow you to proceed with your claim.

If you are looking to take out private medical insurance and you have a pre-existing condition, speak to each individual insurer to see whether they can offer you cover and which type of underwriting might be best for you. While insurers will not include most chronic and long term illnesses in private medical insurance cover, that doesn’t mean you can’t take out cover for future conditions. Remember, it’s important that you disclose any pre-existing conditions when taking out your insurance policy or it may be void.

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