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Pre-Existing Medical Conditions and Health Insurance

As a broker of over 100 health insurance policies we are often asked the question "Can I get coverage for my current illness?" This sometimes applies to clients who have a chronic condition that requires either routine (palliative) care or where an occasional acute event/attack takes place. For example, with Asthma the provision of inhalers would fall under 'routine management' and an asthma attack would be an acute event.

Equally we find that many clients have pre-existing medical conditions that one may not consider to be current – an example of this may be high blood pressure that is managed by regular medication, or diabetes that is well managed with insulin or dietary adjustments. Many clients hold the view that because the condition is managed it is not currently a condition. We also encounter situations where a client has a medical condition that does not require medication or routine management and which has not caused acute episodes.

Both medically, and in terms of medical insurance, the fact that a condition is managed or does not require management does not alter the fact that the condition exists. In this situation, health insurers will regard the condition to be a 'Pre-Existing Medical Condition' which leads us to ask the question "will my insurance cover my condition?"

The question is relatively simple to answer in most circumstances, and to demonstrate the point ask yourself this question: "If I crashed my car on Monday, could I go to a car insurance company on Tuesday and buy insurance that will pay to repair my car?" I suspect most of us would say no, and we would be correct. In general the same applies to health insurance companies – they will not take on a 'risk' that already exists.

So, are there any exceptions to this rule? Luckily, yes there are exceptions, in some circumstances:

  • The first and simplest exception is where a pre-existing medical condition has gone away – for example a hernia that has been operated on and has not re-manifested itself since, or a bad back that has been dealt with and is now no longer a problem. Note, the point here is that the condition has actually and genuinely gone away. A hernia that has been operated on but that still causes pain has not gone away – it is current. Equally, a person who has asthma but never has attacks and never uses an inhaler still has asthma nonetheless.
  • The second exception is in relation to medical conditions that exist but do not show symptoms and do not require medication or medical advice for a period of two clear years. These conditions can gain full coverage under what is called a Moratorium (rather than Full Medical Underwriting).
  • The third exception is where upon application the health insurance company runs Full Medical Underwriting (meaning they ask you medical questions and then assess your individual circumstances), and decide that they are happy to cover the pre-existing medical condition. This inclusion of the pre-existing condition is usually at a 'loaded premium' meaning they will cover the condition but you will have to pay more than the standard premium rate. This is usually only possible with minor medical conditions or illnesses.
  • The fourth exception is available with only a few insurance companies – Aetna is an example with their PPO insurance product which will cover pre-existing medical conditions. This option is generally very expensive and the medical plan is often limited in other areas to account for the fact that the insured person will likely claim for the pre-existing condition at some point during the policy.
  • The fifth and final exception is where an insured person is a member of a large Group Policy which is usually only available through an employer. In these circumstances insurance companies often hold the view that due to the bulk buying of policies by the Corporate Client they will allow MHD – Medical History Disregarded. This means they will not ask about the medical history of the individuals insured under the group plan and as such they will cover pre-existing conditions too.

So, what is our professional conclusion at Alliance Insurance Services? Well, there is no 'one size fits all' answer. The right solution depends on your individual situation. To explore whether or not your particular pre-existing condition would be covered by an insurer please do contact us – we will always be happy to give free, impartial advice and to guide you through the process.

We can be contacted any time at:

  • www.alliancegroup.com.hk
  • enquiries@alliancegroup.com.hk
  • +852 2891 8915

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