How Pre-Existing Conditions Affect Your Health Insurance

When it comes to health or medical insurance, many people are excited to get it. This is because medical insurance policies cover treatment, hospitalization, surgery and other claims. It offers many benefits, especially in unexpected situations or emergencies.

However, in order to obtain health insurance, you usually have to undergo certain health evaluations, provide access to health records  or declare your health conditions to the insurance provider. 

The main reason is so that the insurance provider can determine if you have a pre-existing health condition that might affect the claims you make. 

What are pre-existing conditions?

Pre-existing conditions are illnesses or medical conditions that a person already faces when they want to purchase an insurance policy, usually a health or medical related product. 

This illness can be either physical or mental.When it comes to physical illnesses, they are for the most part chronic illnesses. Chronic illnesses are long term illnesses that have to be managed by an individual with continuous therapy, medication and procedures. 

Can I still purchase medical insurance?

The good news is that you can still be covered by medical insurance with pre-existing conditions. Legally, no insurance provider can deny you coverage. 

However, there will be some changes to aspects of the policy that are different from those that apply to other normal, healthy individuals. Among the differences include:

• Your pre-existing condition(s) and complications arising from it will not be covered under the policy. This is known as specific exclusion. 

• There may be higher premiums that you have to pay if you choose to take the medical insurance with a pre-existing condition.

• Some insurance providers will only allow you to take certain, more suitable medical plans if you already have a pre-existing condition. 

What are some examples of pre-existing conditions?

The list of pre-existing conditions that face specific exclusion in a medical policy depends very much on the policy itself and the providers. 

Here are some of the pre-existing conditions that will typically be included in an insurance provider’s list:

Heart Disease

Heart disease covers a range of illnesses that affect the heart’s ability to pump blood efficiently throughout the body. This includes problems with the blood vessels, valves, heart muscles, heart structure and the like. Sometimes, patients are born with congenital heart disease and face them from birth.

One example of heart disease is coronary atherosclerosis, whereby cholesterol deposits or plaques build up in the major vessels supplying blood to the heart muscles. This can lead to heart attacks, angina or chest pains, and stroke.

Diabetes Mellitus

Diabetes is a chronic condition whereby the body cannot convert excess sugars in the blood into its storage form, causing high levels of sugar to remain in the bloodstream long after meals. 

Typically, a healthy body breaks down carbohydrates that are consumed during a meal into glucose. The body cells consume the glucose that it needs for energy, and the rest is converted into a storage form called glucagon. The enzyme responsible for this is called insulin, made in the pancreas. 

There are two types of diabetes, called Type I and Type II. Type I diabetes patients typically have this condition from very young, and their bodies cannot produce adequate insulin leading to the need to take in intravenously via an injection regularly. 

Type II diabetes patients, on the other hand, make enough insulin in their pancreas, but their cells are highly insensitive to it and don’t use it the correct manner. 

Diabetes is controlled via medication and insulin injections, as well as lifestyle changes like exercise and a low carbohydrate diet. 

If it is poorly controlled, diabetes can cause many complications including heart disease, nerve damage, slow wound healing, eye disease and many others. 

Cancer 

To be clear, cancer is not just one condition but a series of conditions affecting different organs and parts of the body. 

Normal cells have the ability to know when to stop reproducing and growing, but cancer cells have mutated to lose this ability, and therefore experience overgrowth. This results in a tumour or mass.

The overgrowth of cancer cells can cause various problems to an individual. This includes disruption of the body’s systems like the immune and metabolic systems. They can also cause spatial pressure, whereby the tumour presses up on its surroundings. 

Cancers are usually categorized into four stages when they’re diagnosed, depending on the severity and advancement of the growth. They’re also categorized into either malignant tumours or benign tumours. Malignant tumours can travel and affect other organs, whereas benign tumours are localized. 

Asthma

Asthma is an allergic lung disease whereby patients experience breathlessness, coughing, wheezing and chest tightness. This reaction is often due to exposure to certain allergens, which can include things like dust, dander, spores, dust mites, cigarette smoke and more.

Asthmatic patients often experience symptoms from the time they’re children. Asthma can be managed with oral medication and inhalers. For the most part, asthma is not fatal if it is treated early on with the onset of symptoms.

Symptoms usually settle down and become less severe with age. However, patients should still monitor themselves and avoid asthma triggers.

Other Diseases and Conditions

Declarations of mental illnesses like depression, schizophrenia and anxiety are also required by most insurance providers.

Additionally, there are some common illnesses that insurance companies define as pre-existing conditions, such as high blood pressure, high cholesterol, uric acid, fatty liver and much more. 

Why are pre-existing conditions a concern for insurance providers?

The reason is simple. Patients with pre-existing conditions tend to require more medical attention than healthy individuals. As such, they pose a higher risk and cost to insurance providers.

However, insurance providers will still provide products to those with pre-existing conditions. Either a higher premium (called premium loading) will be charged, or a separate product that isn’t affected by the pre-existing condition clause will be recommended. 

Do speak to us if you have a pre-existing condition and want to be covered with a medical policy, as there are many options for you.