Having a complicated medical history or simply a non-life threatening chronic medical condition can often lead to exclusions or price surcharge when subscribing to a new expat health insurance policy. However, it is sometimes possible to find insurance companies who are able to cover these pre-existing conditions. In fact, in recent years, there has been a tendency within the international insurance market to be more flexible when the dealing with pre-existing medical conditions. This has led to an increased willingness to look in options for the client and potentially offer cover with certain additional conditions added to the contract.
So, how do you get insured when you have pre-existing medical conditions?
What is considered a pre-existing medical condition?
In terms of health insurance, a pre-existing condition is a medical condition or disease that you have had or that you have suffered from prior to subscribing to your policy.
If you have received medical treatment, advice, medication or experienced symptoms in the years before you subscribe to a policy it may be classified as pre-existing condition and your insurance company may either exclude this condition from the cover, apply a higher premium or even deny insurance, depending on the condition(s).
Examples of pre-existing conditions:
- diseases currently being treated or already cured
- chronic conditions (for example asthma, diabetes, skin or food allergies)
- congenital conditions
- medical conditions following an accident
- a serious illness such as cancer
- any condition for which you have experienced symptoms even if a doctor has not been consulted (for example a mole which may have slightly changed or recurrent back pain)
Pregnancy is also considered a pre-existing condition and will be excluded if you decide to take out medical insurance cover whilst you are already pregnant (more on this in the International Health Insurance and Maternity article).
Depending on the type of the condition, its severity and the underwriting standards of each insurer, a pre-existing medical condition can be subject to a permanent exclusion, a temporary exclusion, or a surcharge. Furthermore, if a prospective client presents too high a medical risk for the insurer, they may also decide to refuse cover completely.
Why do health insurance companies apply these exclusions?
Companies offering international health insurance are not obliged to cover a person if the risk of serious illness is high. Equally, local private health insurance companies in many countries may apply the same system, such as private medical insurers in the UK.
The health insurance companies operate according to similar principles as other types of insurance companies; guard against future risk rather than against anything which is current or has already occurred. For example, in the case of car insurance, it is not possible to buy a damaged car and then insure it so that the insurance covers the repairs. The same principle applies to any type of insurance, and health insurance is no exception. In effect, insurance companies are risk managers and if they covered very high risks or those already proven, they would not be economically viable.
With regards to health insurance, pre-existing medical conditions can often represent a high risk of reoccurrence. Unconditional cover from insurers would lead to economic loss. This would considerably increase their tariffs, which would ultimately render their products financially unaffordable for their policy holders.
However, in practice, a lot of insurers are becoming more and more flexible on the subject of pre-existing conditions and conditions that were excluded in the past are now being covered.
What happens with my health insurance if I have a pre-existing condition?
It’s a fact, people with absolutely no medical history are a minority. Most of us have some sort of medical history, be it a serious disease or a series of small health problems. When the time comes to choosing expat medical insurance, most of us declare a list of pre-existing conditions. The insurance companies are taking this reality more and more into account, and more of them are now willing to cover if not all, some pre-existing conditions, under certain rules.
The decision to exclude or cover a pre-existing condition and the rules applying to them depends on many factors such as the severity and type of the condition, the age of the patient and the practices of each company. Therefore, it can be difficult to establish any general rules, but here are some trends:
If the pre-existing condition is not very serious, or is not chronic, the insurance company may put in place a reviewable exclusion. For example, if in the year prior to the start of the membership you had an ear infection, the insurance company may decide to exclude all infections of this type during the first year of your policy. At the end of this period, if you have not had an ear infection, you may be able to ask the insurance company to remove this exclusion.
With reviewable exclusion the insurer will indicate at what point you can ask for the exclusion to be reviewed. This is generally under the condition that you have not had any treatment/consultations/check-ups/ongoing medication since starting the contract. In this case, the exclusion usually last for 12 – 24 months depending on the insurance company or the condition.
Applying a surcharge
Some insurance companies offer an alternative to exclusions by offering clients cover for pre-existing conditions with the payment of a surcharge. In this scenario, the price of your policy will increase. The insurance company will decide on a case by case basis whether they are able to apply a surcharge, and the amount that the surcharge will represent. If you receive a surcharge, this will mean that your illness and all conditions linked to it will be fully covered. However, sometimes, it may be more economically advantageous to accept an exclusion rather than pay the surcharge.
Covering some common conditions
Other insurers also offer automatic cover for some pre-existing medical conditions which are considered as common or not serious.
For example, Allianz has a list of conditions that it covers. To name a few: coeliac disease, eczema, asthma, acne, epilepsy, gastroenteritis, hypertension, joint pain, osteoporosis, lactose intolerance, Thyroid disorders, Tonsillitis, Urinary tract infection…
However, it is important to note that this is still on a case by case basis and will depend on the individuals profile and the severity of the condition.
Refusal of cover
If a prospective client has multiple pre-existing conditions, the insurance company reserves the right to refuse to cover them. For example, many companies will not agree to cover someone who has had cancer in the five years prior to the application as the risk of recurrence is high.
Many group schemes are offered cover on a ‘Medical History Disregarded” basis. This means that if you are a company or an organisation insuring a large group of people, pre-existing conditions may be automatically covered, provided that there is a minimum number of people on the policy (often 10 or more). More info on international group health insurance here.
Some insurance companies will also be willing to discuss on a case by case basis the cover of the pre-existing conditions you may have. Expat Assure can help you find the insurance company most suited to cover you, taking into account your personal history and pre-existing medical conditions. Feel free to contact us for a non-obligatory health insurance comparison.
Why should I disclose my full medical history?
When applying for a medical insurance policy, you usually have to complete a medical questionnaire which forms the basis for the insurance company to determine the terms of your insurance policy. Other insurance companies offer an application process without any questions about your medical history. This process is called Moratorium. We will focus here on the Full Medical Underwriting application. (Click here for more information on Moratorium and Full Medical Underwriting.)
When completing the medical questionnaire as part of the application process, it is important to disclose your full medical history. This is because at point of claim, if the insurer discovers a medical condition to be pre-existing from before the start of the policy, it is within their rights to refuse the claim and deny cover. This could lead to you paying unexpected medical bills.
Equally, if it is apparent that this information was deliberately withheld, the insurer also retains the right to invalidate the policy, due to non-disclosure. It could potentially be considered a fraud, and the insurer would not be obliged to refund the premium already paid. The insurance company can also ask to be reimbursed for any money it has paid on your behalf, for the now excluded medical condition.
Even symptoms that you have experienced that didn’t lead to a visit to the doctor must be declared. And that’s where a lot of people can become confused, thinking that any medical issue for which they didn’t see a doctor wouldn’t need to be disclosed. However, at point of claim, an insurer will ask when the symptoms first appeared. If they believe that the symptoms are representative of a longer standing condition they will investigate the claim and have the authority to request a medical report from your treating doctor to confirm the extent and duration of your symptoms. This kind of investigation can lead to the decision not to cover medical treatment.
In the case of hospitalisation or any outpatient claims, if the insurance company determines that you were aware of, had consulted a doctor or received treatment for a pre-existing condition not declared on your application, they may also add a retroactive exclusion as well as asking you to repay any money previously paid out for this condition.
Therefore, to avoid any bad surprises, it is very important to disclose your medical history as fully as possible to your health insurance provider when you are applying.
With health insurance, it’s important to make the right choice from the start
It is important to note that insurance companies do not exclude medical conditions which develop after the start of the contract. If you stay with the same insurance company, any medical conditions you develop during the term of your contract will be covered and the company cannot terminate the contract on the basis that your medical condition is expensive to treat. However, if you change insurance company, medical conditions you have developed during your previous contract may either be subject to an exclusion or a surcharge.
Therefore, with health insurance, it is important to make the right choice from the start, especially if you are based abroad and will need your health insurance for many years to come.
A broker such as Expat Assure, who has knowledge of the workings of health insurance companies and market trends, is well placed to help you make the best choice for the long run. If you tell us your specific medical conditions, Expat Assure can also help you find the right insurer for your case. Feel free to contact us directly or fill in a form online to request your insurance comparison.
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