What is an acute condition?
Acute conditions are illnesses and injuries that arise suddenly and can be treated quickly. The vast majority of private health insurance policies are designed to cover this type of illness. For example, if you break your leg, private medical insurance would enable you to seek fast treatment in a comfortable and private environment, getting you back on your feet (or back to work) as quickly as possible.
What is a chronic condition?
A chronic condition is a medical condition that continues to affect you over a long period of time. Unlike an acute condition, a chronic condition is likely to recur.
Can acute conditions be considered ‘pre-existing’ in insurance terms?
Acute conditions that arise as a result of a chronic condition may not be covered by your insurer. For example, if you are diabetic, exclusions may apply to any short-term illnesses arising as a result of your diabetes.
If you are disabled, you will still be able to obtain cover, but you may not be covered for illnesses arising as a result of your disability. Your insurer is required to demonstrate that any restrictions are not unfair or unreasonable.
What kinds of illnesses are considered pre-existing conditions?
Anything that affects or has affected your health before you take out insurance is considered a pre-existing condition. Most people are aware that pre-existence of cancer, diabetes or heart disease counts as a pre-existing condition, but remember that some policies will prohibit treatment for hay fever, high cholesterol or serious asthma, for example.
Can I get private medical insurance if I have a pre-existing condition?
Yes, you can, with certain limitations. Although some policies will completely exclude your pre-existing condition, others may apply a limitation of some kind. For example, it is common for pre-existing conditions to be excluded for the first two years of your insurance. Once you have enjoyed two years without a recurrence of your pre-existing condition your insurance is ‘reset’. Any recurrence after the two year period will count as a new claim.
This is not always the case, however. Serious conditions such as cancer may never be covered under these rules. Different insurers take different views of pre-existing conditions, so it’s always best to speak to a broker to determine the right policy for you.
Will I be covered for drugs and prescriptions relating to my pre-existing condition?
Generally, no, although you could consider a health cash plan. Cash plans are not insurance but instead help towards the cost of treatments and prescriptions.
Will I be full covered apart from my pre-existing condition?
You will probably not be covered for issues arising as a result of a pre-existing condition, or acute conditions that are related to it. The rest of your private medical insurance cover will not be affected. If you are taken ill with an unrelated condition, you will benefit from the same level of care as any other insured patient. You will be treated promptly in a private hospital where necessary, and the facilities on offer are incredibly modern and private. Private medical insurance is still a worthwhile investment, even if your cover for your pre-existing condition is curtailed.
Will I pay more for private health insurance if I have a pre-existing condition?
In general, no. You will usually pay the same premium as you would have if you did not have the pre-existing condition. However, this is on the understanding that certain limitations will apply to your cover as outlined above.
Remember that premiums for private medical insurance do rise over time, and this is not particular to people with pre-existing conditions. New therapies, drugs and technology tend to push prices up annually, as does the increased risk of illness as you age.
Do I have to declare pre-existing medical conditions that are being treated successfully?
Your pre-existing medical condition may be controlled by medication, physiotherapy or other treatments, but that does not mean it is ‘cured’. Anything you are receiving treatment for must declared to insurers to avoid invalidating your claims in future.
If I develop a condition while I am insured, can I switch health insurance company?
Some insurers offer a No Worst Terms switch arrangement. This means that your old cover is transferred to the new insurer, and the new insurer will closely match the cover you already pay for. Any conditions which developed under your current insurer will then be included in your new cover arrangements and will not be considered pre-existing conditions. You therefore won’t be subject to any waiting periods before you can claim for them.
If you are considering switching private medical insurance it’s very important to speak to a broker to determine whether this applies to your new policy. Switching health insurance without checking first can be an expensive mistake, and it could even negate any savings you make by switching insurer in the first place.
