Pre Existing Conditions Health Insurance
Pre-existing Conditions
There are a number of conditions for which you will be unable to get PMI cover. In addition, insurers will not automatically offer cover for previous illnesses or treatment you have had or are in fact still being treated for. These are called PRE-EXISTING CONDITIONS.
Insurers may sometimes ask for a medical history questionnaire to be completed and signed or may write to your Doctor, or ask you to undergo a medical examination.
Medical background information can often be vital to prove validity (or not) of future claims. If you are unsure, then declare the medical background at the time of application. If you have a medical condition which is likely to re-occur, the insurer will probably exclude that condition or charge an additional premium to cover it. Thus your Plan offer may be on the basis of a continued personal medical exclusions (CPME) transfer or switch. For example, from your company scheme, when you leave.
The second method of application does not require, at the time of applying, any evidence of health, but simply proceeds on the basis of a Moratorium regarding any pre-existing conditions. This Moratorium may be allowed to expire after a period of usually two years when you have not had treatment nor advice for that pre-existing condition, bringing it under cover in year three. A chronic condition would be probably permanently excluded under this type of Plan. These Plans are quicker and very simple to take out but caution is necessary when considering what treatment you have had in the past five years and whether or not such conditions may re-occur. Sales people should be asked to clarify Moratorium terms particularly how far back the company considers pre-existing conditions.
Disclosure
It is the responsibility of a person applying for medical insurance to disclose medical conditions when asked or if a condition is thought relevant. Non-Disclosure of a medical condition usually results in cancellation of your plan by the insurer with no refund of premiums.
Chronic conditions that already exist are usually excluded from cover, If you are diagnosed with a chronic condition after you join a medical insurance plan the initial treatment is usually covered, the daily maintenance (such as diabetic medication) is excluded. If any further acute phases occur these would usually be covered. Chronic Conditions usually have the following characteristics
- It needs ongoing or long-term monitoring through consultations, examinations, check-ups and/or tests.
- It needs ongoing or long term control or relief of symptoms.
- It requires your rehabilitation or for you to be specially trained to cope with it.
- It continues indefinitely.
- It has no known cure.
- It comes back or is likely to come back.
Exclusions
This is probably the most vital area of reading under a PMI plan after the Moratorium Clause is understood. All policies carry a list of general exclusions from cover and some companies exclude more or place financial limits on certain benefits offered, particularly benefits such as routine dental cover or maternity cover. The most common exclusions are:
- Alcoholism or drug abuse
- GP services
- HIV or AIDS
- Hazardous sports
- Infertility
- Normal pregnancy
- Sterilisation
- Treatment Overseas
- Cosmetic surgery
In addition to any general exclusions, others may be applicable depending on the people who you wish to have covered and their medical conditions. If information on the application form names medical conditions, an insurer may exclude such conditions from cover.