Cover for Pre-Existing Conditions? Just Don’t Lie About It

With the new Dubai health insurance law, coverage for pre-existing conditions is now mandatory. According to ISAHD, medical cover can not be denied due to pre-existing conditions, and the maximum waiting period for such cover must not exceed 6 months. As of January 2015, many health insurance companies in the UAE have revised their product offerings to provide cover up to AED 150,000 for pre-existing and chronic conditions after 6 months.

So does this mean anyone can buy medical insurance and make a claim after the waiting period? As you guessed, it is not that simple. There is a lot of red tape associated with pre-existing & chronic conditions. Firstly, you have to look at what the exact definition of a pre-existing condition is.

What it means

In most insurance policies, the exact meaning of a pre-existing condition is defined in detail. The key points to understand are:

  • it is a health condition that is known or unknown to the policy holder; and
  • it is a condition for which you received a treatment in the form of a consultation, surgery, diagnosis, or pharmaceutical drugs prior to purchasing the insurance policy.

It is important to understand the definition of a pre-existing condition because a universal clause in all policies is that the insurance company has the right to reject any claim if you fail to accurately declare your medical history in the application form. This could lead to a situation where you make a claim, but the insurer rejects it because you failed to declare a pre-existing condition, even if it is unrelated to the claim! So if you take medicine for high cholesterol or blood pressure, you need to mention this in the application form, or the health insurance company has the right to reject future claims.

It is also important to note that congenital diseases and birth defects are not defined as pre-existing conditions; they are typically treated as a separate benefit.

 Mandatory coverage for pre-existing conditions?

When buying health insurance, you have to fill out an application form where you are asked about your medical history in detail. While it may be tempting, you should never lie about it. While existing health conditions can affect the price of insurance (i.e. your premium), lying puts you at serious financial risk in the future. If you suffer a significant, and expensive, medical emergency, the insurance company can decline your claim if they find out about any undeclared condition. This actually happens more often than you think, so make sure you fill out the application form carefully to avoid any future surprises.

While coverage for pre-existing conditions is now offered by most health insurance companies in the UAE, keep in mind that:

  • you must declare it in the application form; and
  • your premium is subject to change.

In practice, after you fill out the application form, the insurer can take several actions if you declare any pre-existing conditions.

  • Medical examination ­– Very often, you will be asked to undergo a medical checkup to provide the insurance company with more information regarding your health.
  • Premium loading – The company will increase the price of your health insurance policy.
  • Exclusion – The insurer will provide you with cover if you agree to exclude treatments related to a specific disease from the policy. In the UAE, this is common when an applicant has diabetes.
  • Waiting period – You may be asked to agree to a longer waiting period for the treatment of specific conditions.

While the Dubai health insurance law mandates coverage for pre-existing conditions, in practice, it is not so simple. Even if a company can not reject you based off a prior condition, you still have to declare it beforehand, and the medical insurance company can increase your premium. However, even with all these terms & conditions, it still makes sense to buy health insurance in the Dubai. While prior medical conditions may not be covered in your policy, un-related treatments are. Moreover, costly hospitalization costs are also covered in case things take a turn for the worst. 

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