What are Pre-Existing Medical Conditions?

Why do Pre-Existing Illnesses Affect Insurance Costs?

Sep 23, 2009

Pre-existing medical conditions can make it harder & more expensive to get insurance. Why is it an issue, why does it increase costs & how do people get coverage?

Consumers who have had certain types of medical problems in the past may find that their health history makes getting insurance coverage more difficult. This is often an issue for them when they try to take out travel, health and life insurance policies. For some, having pre-existing medical conditions may mean that they are turned down by insurers or that they are asked to pay extra to get the coverage that they need.

In the insurance industry this is the term used to describe an illness or condition that an individual has had in a specific period of time before they applied for a policy. Whenever a policy application is filled out, it will ask the individual to list any conditions/illnesses that they may have had, usually within a set period of time (i.e. within the last two years).

The period of time here may vary from policy to policy. Some insurers will set shorter timescales and some will set longer ones. In some cases they may also ask if the individual has ever suffered from certain conditions. There may be no imposed time limits there.

Why do Pre-Existing Medical Conditions Have a Negative Effect on Insurance Policies?

If an individual has had a minor illness or operation that is not likely to cause them problems in the future then this may be discounted by the insurer as a pre-existing condition. If, however, they have ongoing problems or have suffered from a serious illness that could well re-occur (such as cancer or heart problems) then this will usually worry the insurance company.

The worry for them is the fact that the individual may have problems again during their insurance period, leaving the company liable for any costs. They simply view these individuals as being a higher risk as there is an increased chance that they will have to pay out on the policy.

How Long does a Pre-Existing Health Condition Count?

In many cases insurance companies will set time limits on previous problems. So, for example, if their limit is two years then an individual shouldn't technically have problems taking out a policy as long as they have had no problems with their condition for the last two years. Again, time periods vary from policy to policy.

In some circumstances, however, insurers may impose other conditions. They may, for example, treat certain serious conditions as long-term problems and may refuse to approve applications for standard cover if the individual has suffered from these conditions at any point in the past. Some may also impose age conditions. Here individuals under a certain age may be given some leeway but people over that age may not.

How does a Pre-Existing Condition Affect Insurance Applications?

None of these results are ideal. People in this situation may find that they simply get better coverage and lower costs by looking at other options.

How to Get Insurance Coverage With Pre-Existing Conditions

The one thing not to do in this situation is to lie or cover up on a policy application. This would invalidate the coverage if a claim was made and the insurer discovered the truth. Other options include:

It may be that the individual has to pay extra to get the cover they need. If a standard policy won't allow coverage unless the individual agrees to pay extra, they may, however, find it more cost effective to find a specialist provider instead.

The copyright of the article What are Pre-Existing Medical Conditions? in Insurance is owned by Carol Finch. Permission to republish What are Pre-Existing Medical Conditions? in print or online must be granted by the author in writing.