At a Glance

Private health insurance is generally available to people with pre-existing conditions, but those conditions may be excluded from cover. Medical underwriting determines how your history is assessed and what exclusions apply. However, eligible new or unrelated conditions that develop after the policy begins may still be covered, subject to its terms. To understand your options, speak with Heath Crawford.

Jargon Explained

Pre-existing condition: An illness, injury or symptom that existed before your health insurance policy began. The precise definition can vary between insurers and policies.

Full Medical Underwriting (FMU): An underwriting method where you provide information about your medical history when applying, allowing the insurer to determine what conditions are covered or excluded before your policy starts.

Moratorium Underwriting: An underwriting method where you generally do not provide your full medical history when applying. Instead, your insurer assesses your medical history if you later make a claim.

Exclusion: A condition, treatment or circumstance that your policy does not cover. Pre-existing conditions and related conditions may be excluded, depending on the policy and underwriting terms.

Can You Get Health Insurance With a Pre-Existing Condition?

For those asking, “Can you get health insurance with a pre-existing condition?”, the answer is generally yes, although the condition itself may not be covered by your new policy. 

This is because private health insurance is designed to cover eligible medical conditions that arise after you take out the policy, rather than conditions you already know about.

That doesn’t necessarily make private medical insurance unsuitable. While your existing condition may be excluded, your policy could still provide cover if you develop a new, unrelated condition in the future. Depending on the insurer and policy terms, certain new conditions related to an existing condition may also be eligible for cover if they develop after your policy begins.

No one can predict what their health will look like several years from now, which is why having private health insurance in place can provide useful protection against unexpected healthcare needs.

In this blog, we’ll explain how pre-existing conditions are assessed, the role of medical underwriting and what to consider when choosing cover.

How Do Insurers Define a Pre-Existing Medical Condition?

A pre-existing medical condition is generally a disease, illness, injury or symptom that existed before your private health insurance policy began. Importantly, this doesn’t necessarily mean you must have received a formal diagnosis.

Depending on the insurer and underwriting method, previous symptoms, medical advice, treatment or medication may also be considered.

For example, if you experienced recurring back pain or received treatment for a knee injury before taking out cover, these may be treated as pre-existing conditions. Insurers may also consider conditions related to an existing illness when assessing whether a claim is covered.

The precise definition and look-back period can vary between policies, so it’s important to check the terms of your cover and provide accurate information when applying.

How Does Medical Underwriting Affect Your Health Insurance?

Medical underwriting is the process insurers use to assess your medical history and determine what your private health insurance will cover. The effect of medical underwriting on health insurance depends on the type of underwriting used.

With full medical underwriting, you provide details of your medical history when applying. The insurer then assesses this information and may apply exclusions for pre-existing conditions or related conditions. This can give you greater clarity about what’s covered before your policy begins.

With moratorium underwriting, you usually don’t provide your full medical history upfront. Instead, the insurer assesses your medical history when you make a claim to establish whether the condition is pre-existing. The specific terms and qualifying periods vary between insurers.

Will a Pre-Existing Condition Be Covered by Private Health Insurance?

In most cases, a private health insurance policy will not immediately cover a condition you had before taking out the policy. This means if you’re getting health insurance with a pre-existing condition, treatment for that condition or related conditions may be excluded from your cover.

However, the position can vary depending on the insurer and type of underwriting. With some moratorium policies, a pre-existing condition may become eligible for cover if you remain free from symptoms, treatment, medication, diagnostic tests and medical advice for a specified period after your policy begins.

It’s therefore important to check your policy terms carefully. If you’re asking, “Are pre-existing conditions covered by private health insurance?”, the answer depends on the specific policy and underwriting terms.

Myths Vs Facts

Can You Get Cover for New or Unrelated Medical Conditions?

Yes. While a pre-existing condition might be excluded from your policy, private health insurance can still provide cover for new medical conditions that develop after your policy begins. This is one reason why getting health insurance with a pre-existing condition can still be worthwhile.

For example, if you have an existing knee problem that’s excluded from your policy but later develop an unrelated medical condition, your insurer may cover eligible diagnosis and treatment for that new condition, subject to the policy terms.

It’s important to remember that a new symptom or condition may not be covered if it’s medically related to an excluded pre-existing condition. Your insurer may also check when your symptoms first began before approving a claim.

This means private health insurance can still provide valuable protection against future, unexpected healthcare needs.

What Should You Consider When Choosing Private Health Insurance With a Pre-Existing Condition?

If you have a pre-existing condition, look beyond whether an insurer will accept your application. Check how your policy is underwritten, which conditions and related conditions are excluded, and whether any exclusions could be reviewed in the future. Different insurers have different underwriting criteria and terms.

You should also consider the level of cover, excesses, policy limits and which treatments or services are included. Most importantly, answer questions about your medical history fully and accurately. Failing to disclose relevant information can affect whether a future claim is paid.

Remember that private health insurance can still provide cover for eligible new conditions that arise after your policy starts. So, even if your existing condition is excluded, can you get health insurance with a pre-existing condition? Yes, as it may still provide useful protection for future healthcare needs.

Questions to Ask Your Insurance Broker or Insurer Before Choosing a Policy

• Which underwriting method applies to my policy – Full Medical Underwriting or Moratorium Underwriting?
• Which pre-existing conditions, symptoms and related conditions would be excluded from my cover?
• Could an excluded condition become eligible for cover in the future, and what requirements would apply?
• What medical information or records might be needed if I make a claim for a new condition?
• How will the insurer determine whether a condition is new or related to a pre-existing condition?

To Find Out More About Health Insurance for New or Pre-Existing Conditions, Speak to Heath Crawford

Can you get health insurance with a pre-existing condition? In many cases, yes, although your existing condition may be excluded from your policy. The important point is that private health insurance can still provide cover for eligible new and unrelated medical conditions that arise after your policy begins.

No one knows what their future healthcare needs will be. Taking out cover now can therefore give you access to private healthcare for eligible conditions that may develop later, even if your current medical condition cannot be covered.

If you would like to discuss your private health insurance options, Heath Crawford can help you understand the available cover and how pre-existing conditions may affect your policy. Contact us today to discuss your requirements.

FAQs

Is private health insurance still useful if my existing medical condition is excluded?

Yes. Although your existing condition may not be covered, private health insurance can still provide cover for eligible new conditions that arise after your policy starts. This can give you access to private diagnosis and treatment for healthcare needs unrelated to the condition you already had, subject to the policy terms.

What happens if I forget to mention a medical condition or symptom when applying?

If your policy involves medical screening, it’s important to provide complete and accurate information in response to the insurer’s questions. Failing to disclose relevant information can affect whether a future claim is covered and, depending on the circumstances, can lead to disputes about non-disclosure or misrepresentation. If you’re unsure whether something is relevant, it’s sensible to ask the insurer or broker rather than leave it out.

Can an insurer check my medical records when I make a claim?

Depending on the policy and underwriting method, the insurer may request medical information to establish whether the condition is new, pre-existing or related to an excluded condition. The evidence considered can include medical records and information about previous symptoms, consultations and treatment.

Lawrence Canning