Pre Existing Conditions

• Conditions existing now or recently before applying for a new plan are excluded automatically
• Cover is possible of pre-existing conditions if fully described in detail & accepted by company
• Premium rate-up, limited cover and/or special term may be offered on such conditions
• Group plans are more liberal if size is over 50 people or a takeover of another plan exists

All International Medical Insurance and HealthCare Plan companies have a written list of standard exclusions within their plan document. The exclusion that normally tops the list and seems most important to all planholders is called “pre-existing conditions”. There are a number of written definitions of Pre-existing conditions (PEC) but most are along the lines of the following definition.

“Any condition which one is diagnosed to have, aware of, any reasonable person should be aware of, has been treated for within the past two years, currently being treated, has been recommended for treatment or providing symptoms of within the past two years”

Some Companies require the planholder to have a two-year period (moratorium) free of any medical consultation, examination or treatment of any PEC before it would be covered. This two-year period starts from date of enrollment into their plan. Others can require medical histories going back further than 2 years to determine whether or not they will except the applicant (underwrite) with such PEC history. The acceptance may be with or without premium rate-up or a limit of coverage on such condition or with placing of a special plan condition regarding treatment relative to the PEC. Some firms will simply exclude PEC and allow reviews at each renewal to determine if it can be reconsidered for cover or not.

To obtain best terms and options group members should fully disclose accurately and in some detail all PEC when completing plan application forms. Rejection of future PEC claims is probable if member knowingly omits material facts when applying for cover initially. Even the entire policy can be placed in jeopardy because of omissions. It is best for members to be required to disclose all known medical history and current health status when applying for entry to the group plan. In some group plans PEC can be covered if group size is over 50 or 100 members. If a plan is being taken over from another Plan Company, a waiver on PEC could be requested. The new Plan Company as part of a group’s application for a waiver may request a claims history report. Group plan applications contain fewer questions about medical histories than individual application forms and thus are more liberal. The key to obtaining proper coverage is to read all application questions very carefully, answer them thoroughly and honestly.