April 2021
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Health Insurance And Existing Health Issues

Most people are aware that health insurance doesn’t cover pre-existing health conditions. But what does a health insurer really consider to be ‘pre-existing’? We’ll take a look at three common examples…

1. Current health problems

In short, if you’re aware of a health problem (whether it’s been fully diagnosed or not), or have started to develop symptoms then an insurer is going to consider this a ‘pre-existing’ condition, and won’t be able to offer cover under your health insurance.

But what if you didn’t know about the problem?
This actually varies depending on the health insurance plan that you have. Some health insurance plans have a stand-down period during which no claims at all can be made. However most of the health insurance plans that Inform recommends have a better approach. With these plans, if you were totally unaware of an issue (for example had no symptoms and no clue that anything was wrong) then the problem is not likely to be considered ‘pre-existing’. In other words, if you start your health insurance and one day later a brand new health problem emerged, then you’d be able to make a claim straight away.

2. Health problems that have happened very recently

Let’s say you injured a knee a few months ago and had successful surgery to repair the problem. Even if the surgery was a success, an insurer would be likely to put a temporary exclusion on your health insurance policy. Why? Health insurers like certainty, and until time has passed it’s very hard to predict whether a problem really has been resolved. In these situations, time is the key. Once 12 or 24 months have passed with no further problems, you could ask that the exclusion be removed from your health insurance.

3. Past issues that are very likely to reoccur.

An example is if you had a long history of back pain, which has come and gone regularly over a number of years. Given this history, it’s quite likely that the pain will occur again – and so the insurer would probably exclude this from your health insurance.

Discussing any possible existing issues with your health insurance adviser is a smart move. They can help you present these in the best way to the health insurance company – giving you the greatest chance of getting cover and the least possible chance of a nasty surprise at claim time.

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