A pre-existing condition is a medical condition that existed before a person’s current health insurance plans began. This can include a wide range of conditions, from chronic illnesses like diabetes or asthma to more specific issues like previous surgeries or past injuries.
In many insurance plans, pre-existing conditions were historically a factor that could impact coverage, but recent reforms in some regions, like the Affordable Care Act in the U.S., have made it illegal for insurers to deny coverage or charge higher premiums based on these conditions.
Examples of pre-existing conditions
Here are some examples of pre-existing conditions that health insurance companies in Sri Lanka and elsewhere take into account when issuing coverage:
- Chronic diseases: Diabetes, hypertension, asthma, or chronic obstructive pulmonary disease (COPD).
- Heart conditions: Coronary artery disease, heart failure, or previous heart attacks.
- Cancer: Any type of cancer, including breast cancer, lung cancer, or prostate cancer, diagnosed before the start of a new insurance policy.
- Autoimmune diseases: Rheumatoid arthritis, lupus, or multiple sclerosis.
- Mental health conditions: Depression, anxiety disorders, or bipolar disorder.
- Previous injuries: Severe injuries from accidents or surgeries that have ongoing effects or require ongoing treatment.
- Pregnancy: If you are pregnant before getting new insurance coverage, it is often considered a pre-existing condition.
These conditions can impact how insurance policies are written and what coverage is provided, though regulations may vary by region and policy type.
Four facts about getting disability insurance with a pre-existing condition
Here are four key facts about obtaining the best health insurance disability cover with a pre-existing condition:
- Coverage Limitations: Insurers often have specific rules regarding pre-existing conditions. They might limit coverage for disabilities related to the pre-existing condition, or exclude it entirely for a certain period after the policy starts. This means if you have a pre-existing condition, you might face restrictions on claims related to that condition.
- Waiting Periods: Some insurance policies include a waiting period for coverage of pre-existing conditions. For example, there might be a waiting period of 6 to 12 months during which you cannot claim benefits for issues related to the pre-existing condition.
- Higher Premiums: You may face higher premiums due to the increased risk associated with pre-existing conditions. Insurance companies often adjust rates based on perceived risk, which can result in higher costs for those with pre-existing conditions.
- Disclosure Requirements: It is crucial to fully disclose any pre-existing conditions when applying for disability insurance. Failure to do so can lead to denial of claims or cancellation of the policy if the insurer discovers the omission later. Full disclosure ensures that the terms and coverage of the policy are clearly understood from the outset.
Different insurance companies and policies may handle pre-existing conditions differently, so it is important to review the terms and consult with an insurance advisor to understand your specific situation.
How to ensure that you get disability cover when you have a pre-existing condition
Securing disability insurance with a pre-existing condition can be challenging, but here are some strategies to improve your chances:
- Research Insurers: Look for insurance companies known for being more flexible with pre-existing conditions. Some insurers specialise in providing coverage for individuals with health issues. Consulting with a broker who has experience with high-risk insurance can also be beneficial.
- Disclose Fully: Be transparent about your pre-existing condition when applying for disability insurance. Full disclosure helps avoid future issues with claims and ensures you understand any limitations or exclusions related to your condition.
- Review Policy Terms: Carefully examine the policy details, especially regarding coverage exclusions and waiting periods for pre-existing conditions. Look for policies that offer the most comprehensive coverage possible.
- Consider Employer Coverage: If you are employed, check if your employer offers disability insurance as part of the benefits package. Employer-sponsored plans sometimes have different rules and might be more accommodating compared to individual plans.
- Seek Legal or Financial Advice: Consulting with a financial advisor or attorney who specialises in insurance can help you understand your options and navigate complex insurance policies, ensuring you make informed decisions.
- Look for Group Policies: Group disability insurance plans, such as those offered by professional associations or unions, may have more lenient terms regarding pre-existing conditions compared to individual policies.
These steps can help you improve your chances of obtaining disability insurance that meets your needs despite having a pre-existing condition.
Is it illegal to not disclose such pre-existing conditions when getting health insurance or disability cover?
Yes, it is generally considered illegal and unethical to withhold information about pre-existing conditions when applying for health insurance or disability coverage. Here is why:
- Fraudulent Misrepresentation: Providing false or incomplete information on an insurance application can be considered fraudulent misrepresentation. If an insurer discovers that you did not disclose a pre-existing condition, they may deny coverage, cancel your policy, or refuse to pay claims related to that condition.
- Policy Terms and Conditions: Insurance policies typically include a clause requiring full disclosure of all relevant medical information. Failing to disclose a pre-existing condition can violate these terms, leading to potential legal consequences and denial of benefits.
- Legal Consequences: In many jurisdictions, insurance fraud is a criminal offence that can result in legal penalties, including fines and imprisonment. Insurance companies may also pursue civil actions to recover losses incurred due to fraudulent claims.
- Impact on Coverage: Withholding information can lead to complications if you need to make a claim. Even if your policy does not specifically cover the pre-existing condition, a lack of disclosure could cause the insurer to investigate and potentially refuse coverage based on the initial misrepresentation.
Always provide accurate and complete information when applying for insurance, whether it is a life insurance policy or health insurance. This not only ensures that you comply with legal requirements but also helps you avoid complications with your coverage in the future.
