Pre-Existing Medical Conditions & Medical/Travel Insurance

As to whether pre-existing medical conditions would be covered under a new insurance plan, this will very much depend on what type of insurance plan you are considering, the nature of the condition, how long you have had it, what treatment you have had or are still having and other factors which may need to be taken into account.

Travel Insurance

If you are looking for cover for a single, short-term trip outside of your home country, or multiple trips over a twelve-month period, it may be that a Travel Insurance plan will fit your needs.

There are travel insurance plans available whereby the insurance company may be able to offer coverage that does include pre-existing conditions. With these companies, clients are required to undergo telephone “screening” – providing details of the relevant conditions to the insurer.

The insurance company may then apply additional premiums (“loadings”) to their standard rates in order to offer cover for the pre-existing medical condition. This is not guaranteed, and there may be circumstances where pre-existing conditions are covered without extra charge, but there may also be instances where coverage for a condition is declined (although unrelated conditions will still be covered).

An expert broker should be more than able to guide their clients to finding the most appropriate travel insurance for their needs.

Private Medical Insurance

If you are an expatriate or are looking for long term coverage in your home country, a full Private Medical Insurance plan may best suit your needs.

With regards to how this type of plan will treat cover for any pre-existing condition, this will be directly influenced by the type of underwriting employed by an insurer or plan provider. This is either on a "Full Medical Underwriting " or a "Moratorium" basis.

Where an insurance plan is "Fully Medically Underwritten", medical history is disclosed on the application form. This is then assessed upon submission, by that insurer's underwriters on a case-by-case basis. Once assessed, the application may be accepted without exclusions, accepted with exclusions, accepted at a higher premium to cover pre-existing conditions (a “loading”) or declined altogether.

Under this system of underwriting it is impossible to give a 100% accurate assessment of the effect a pre-existing condition may have on an application for cover without actually submitting an application - as everyone's individual circumstances are different, a case by case approach is necessary. It is an unfortunate fact, however, that the more serious and/or long term a condition is, the less chance there is of having it covered by a new medical insurance plan.

A Moratorium is a waiting period that must elapse before claims for pre-existing conditions may become eligible under a new Private Medical Insurance plan. Whilst an application form for this type of underwriting may not ask for any medical information to be disclosed, there are specific rules and conditions that must be met before pre-existing conditions would be considered for cover. This may be that any conditions that have presented symptoms or have had treatment or advice in the two years prior to the start of an insurance plan would be excluded until two continuous years have passed from the start of a plan without any signs, symptoms, treatment or advice.

Under the "Moratorium" system of underwriting, it may well be that pre-existing medical conditions may never be covered but cover could still be given for new and unrelated illnesses and diseases.

By seeking independent and impartial advice through a broker such as Medibroker, customers can benefit from a wide range of options across different types of medical insurance in order to obtain the most suitable plan for their individual needs.

This article is intended as a "quick reference" guide to Pre-existing Medical Conditions, and is not a full and comprehensive guide to policy benefits and limits. Full details of coverage provided by each Insurer / Plan Provider are contained within their plan rules and/or policy wordings, which are available upon request.

Andrew Wilson

Sales and Business Development Director

Medibroker Limited

Prepared for the TalkHealth newsletter.

2nd May 2007

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