Brokerfish

Pre-existing conditions

Pre-existing conditions, including chronic conditions, are generally not covered under individual or family health insurance policies unless they have been specifically declared and accepted by the insurance provider, and in some cases, this may be subject to an additional premium. A pre-existing condition is a medical condition that existed before the start of an insurance policy.

Situations when pre-existing conditions are excluded from coverage include, but are not limited to:
» Conditions that are indicated on a Special Conditions Form issued by the insurer before the policy starts
» Conditions that were not disclosed on the Application Form

Conditions that arise between the completion of the application form and the later of the following:
The date the insurer issues the Insurance Certificate
» The start date of the policy

Such conditions may also be subject to medical underwriting and if they are not disclosed, they will not be covered.

On the other hand, group policies usually have the option to arrange coverage for pre-existing conditions for groups as small as 5 employees. However, in this case, it is important to disclose any material facts, such as a member suffering from a condition such as cancer and undergoing ongoing treatment. The insurer may choose not to insure the group based on this disclosure. For larger groups, the insurer may only require the disclosure of conditions that are known to incur costs of more than 100k USD. However, any material fact should always be disclosed.