How Pre-existing Conditions are Handled by Insurance

How Pre-existing Conditions are Handled by Insurance

 

For many of us who have bought health insurance before, the term ‘pre-existing conditions’ is a major cause of stress. Will a certain condition be covered? How much will the coverage be? How much will the premium be loaded? What about the waiting period?

There are many questions and factors to look at when purchasing a health insurance policy – here are some key points to keep in mind when it comes to Pre-existing Conditions.

What is a pre-existing condition?

Some of us mistake pre-existing conditions as ‘an illness or condition that a person might have at the time of buying a policy’.

Well, pre-existing condition does not only refer to an illnesses that a person has at the time of buying a policy but it also includes a thorough medical history of any condition ranging from heart attacks, diabetes, past hospitalizations, any surgeries, medications for any disease or illnesses like high blood pressure or thyroid, skin disorders, major accidental injuries and any signs or symptoms such as increase in sugar, or high blood pressure. In other words, the insurance company wants to know about absolutely any disease, condition or injury you’ve had.

All insurance companies have their own take on ‘pre-existing conditions’ so you need to read the literature very carefully.

By and large, under the standard definition, ‘a pre-existing condition is any condition for which the patient has already received medical advice or treatment prior to enrollment in a new medical insurance plan.’

This means that a pre-existing condition refers to any health problem faced by the individual prior to seeking health insurance. Usually there is a ‘look-back’ period of around five to ten years which the insurance company investigates.

Important disclaimer - part of the definition of a pre-existing condition is that it is ‘a medical condition that is known OR unknown’. This means that if you have a disease that existed before you bought a medical insurance policy, but you didn’t know about it at the time, it is still considered a pre-existing condition!

Insurance companies dislike pre-existing conditions

Until recently, most health insurance policies would exclude cover for pre-existing conditions along with all related conditions. For example, someone suffering from high blood pressure would in all probability also have exclusions placed on their policy for angina, aneurysm, heart attack, stroke etc. This would also be the case even if the condition was under control with medication.

Insurers are reluctant to provide coverage to people who suffer from pre-existing ailments. This is because such people are more likely to require treatment and thus, present a higher financial risk to insurance companies

So if I have a pre-existing condition, can I buy an insurance plan which will cover it?

Under the Dubai Health Authority’s new insurance law, insurers will not be permitted to deny individuals medical insurance coverage due to pre-existing conditions although treatment for chronic and pre-existing conditions may initially be excluded for the first 6 months of cover.

Many insurance companies in the UAE now provide cover for pre-existing conditions, however, there are a few steps they take to mitigate their risk. The following methods will likely impact you if you have an existing condition:

  1. Premium Loading: The insurance company will include the pre-existing condition, but charge a higher annual premium.
  2. Waiting Period: Waiting periods prevent you from making claims soon after signing on to an insurance plan, or from claiming on pre-existing conditions. The duration of a waiting period varies among insurance companies. While the Essential Benefits Plan in Dubai states the waiting period as 6 months, in serious cases you might have a negotiated waiting period that is much longer.  
  3. Premium loading + waiting period: You may have both premium loading and a waiting period.
  4. Exclusion of Pre-existing conditions: The insurance company will offer the applicant medical insurance coverage, but exclude the pre-existing conditions. This means the insurance company will not cover the costs of all treatment and services stemming from this medical condition.

The best way to make sure that you have coverage for any medical conditions that you develop is to stay with the same company for the long-term. Insurance companies cannot deny you a renewal on your policy even if you develop a chronic or serious medical condition, as long as you have already been accepted into the plan. However, they can still increase the renewal price each year.

Another possible way to get coverage for a pre-existing condition is to apply for a group policy. If your company is large enough, the insurance company may cover the pre-existing conditions of all members of the group.

Why choose a Group Medical Insurance Plan

The new health insurance law in Dubai has made it mandatory for all employers to provide health cover for all staff. This includes residents and expatriates.

When taking a group medical insurance plan (larger number of members), an insurer knows that they get a mixed population of both health and un-healthy individuals. They do not need to individually underwrite people because of the higher volume. Thus they are happy to cover pre-existing conditions and chronic conditions because they know given the size of the group; the payout will be proportionately smaller.

The minimum number of employees to qualify for a company health insurance plan, and waive any pre-existing condition underwriting, varies greatly amongst insurance companies in the UAE. It can be as little as 10 employees or as high as 50 members.

Shopping Tips

  • Different insurers have different policies and different waiting periods. Compare insurance plans through a platform like Bayzat.
  • Premium loadings can sometimes be reviewed in the future with a view to reducing or removing the loading. It is also worth applying to more than one insurer to see who offers the best terms (i.e. smallest premium increase). 
  • Don’t lie. This is a bad tactic because if you do end up requiring treatment for such a condition, the insurer could reject your claims.

If you do have a pre-existing condition, getting the right health insurance plan can be very difficult. Comparing medical insurance options on Bayzat is a great first step in finding the right plan. Thereafter, our customer service team will walk you through the whole process, deal with underwriters on your behalf and find the right policy for you and your pocket.

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