Guide to health insurance exclusions: Pre-existing conditions

health insurance exclusions

If you’re reading this, you know that health insurance is important. It can help you save money yet get the very best treatment in the event of a serious illness or accident. However, you want to make sure you understand what is not covered (also known as ‘exclusions’) before you purchase a plan.Most private health insurance policies are designed to cover new medical conditions that occur after your insurance policy goes into effect. Health insurance companies refer to medical conditions that you have before your policy starts as “pre-existing conditions”. 

What is a pre-existing condition?

Pre-existing conditions are medical conditions that you have before your health insurance policy starts

So what do health insurance companies mean by “pre-existing condition”? A pre-existing condition can refer to the following:

  • A past injury or illness that you have already recovered from (such as a broken ankle from your youth)

  • Symptoms which you have yet to seek medical advice, treatment or consultation (such as pains, lumps, bleeding etc.)

  • Any ongoing treatment you are currently receiving (such as medications or other forms of therapy)

  • A condition you already have, but you are not aware of (for example, a growing tumor in your body)

Will all your pre-existing conditions be excluded from coverage? Not necessarily. The degree to which your pre-existing condition can be accepted will vary according to company and health insurance plans.

health insurance policy

Always declare your medical conditions when filling health insurance application

One effective way to find out if your pre-existing conditions will be covered is to make the health insurance company aware of it through a medical declaration – and ask for their terms of acceptance.In addition to the medical declaration, you are recommended to ask the following questions: 

If I go see a doctor a week after my policy starts, will I be covered?

Here are some possible scenarios:

  • If the visit is related to a symptom you experienced before your plan started (such as a pain in your right leg) then it will be considered as ‘pre-existing’ and most insurance companies will not cover it.

  • On the other hand, if you were feeling great with no symptoms at the plan start date, but a week later contracted malaria leading to a stay in the hospital; then most health insurance plans will cover it – as it is not ‘pre-existing’. Be aware than many health insurance plans impose a waiting period on certain benefits. For example, some companies may exclude all treatments other than accidents for the first 30 days of the policy.


What if there were no symptoms when I purchased my insurance and I am later diagnosed with a tumor that had been in my body for months before my insurance plan started, will I be covered?

Here are some possible scenarios:

  • Some health insurance companies will consider this tumor as pre-existing – because it existed before the time your plan started – and will not cover it.

  • On the other hand, some health insurance companies will not consider this as pre-existing – as you were not aware of it at the plan start date.

If I am currently taking medications or receiving treatments, will I be covered?

Consult your health insurance representative about ongoing medication
Most private health insurance policies will not cover ongoing treatments. However some companies may charge you extra in order to cover these conditions.

If I’ve experienced an illness or injury in the past and I’ve fully recovered, will I be covered for these conditions if they re-appear?

This will depend on the chance of the condition re-appearing as well as the underwriting terms and varying practice of different companies.

health insurance medical exclusions

The bottom line:
Different health insurance companies have different approach to ‘pre-existing conditions’. Read their definition, declare your medical conditions and ask the right questions to ensure you understand the coverage before you buy.

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