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If I have a pre-existing medical condition can I obtain medical insurance?


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Q:

Can I get medical insurance when I have a stent placed? I had a stent placed late 2011. Medication since. Had several check-ups and no further complications since.

A:

It is possible to obtain a Hong Kong health insurance plan if you have a pre-existing medical condition. However, most insurers will exclude the pre-existing condition from coverage under the policy.

CCW Global works with a large number of Hong Kong and International Health Insurance providers and can offer a wide range of both domestic and international medical insurance plans depending on your needs. But in relation to pre-existing medical conditions, no matter which company you choose to purchase a policy from, the condition will normally be handled in one of 4 ways under the policy.

Exclusion from Coverage

The most common way for insurance companies to handle pre-existing medical conditions is to simply exclude the condition, and all related conditions, from coverage under the plan.

This means that while you would be able to receive medical insurance coverage, the insurance would not cover the costs of any treatment relating to your stent. Any treatment you may receive which is not related to the stent would be covered as normal under the policy up to the stated policy limits.

In this case it is important to note the language that many insurers will use in relation to a coverage exclusion – particularly when “any related condition” is stated. Because it can be difficult to diagnose individual heart conditions, it is likely that any insurance policy for which you are accepted with an exclusion would then exclude the costs of treatment in relation to any heart treatment you may require in the future.

A majority of both local and international health insurance providers operate with an exclusion approach to pre-existing conditions, so it is important to be aware of this when considering your options.

Coverage with a Moratorium

A second way in which pre-existing conditions can be handled, which is more common with Domestic Hong Kong health insurance providers, is the opportunity for coverage with a moratorium.

Simply put, a moratorium is a waiting period; a period of time for which you must have held the policy before being able to claim for the costs of treatment associated with a specific benefit or condition.

In the case of pre-existing conditions the moratorium will normally be at least 24 months from the start of the plan (the time coverage went into force). If you have held a moratorium health insurance policy for at least 2 years, and have no experienced any symptoms, nor received any treatment or medication for the condition, then the insurer may elect to offer coverage for the condition when you renew the policy at the start of your third year.

As mentioned here, moratorium options for pre-existing medical conditions are most commonly found on Domestic Hong Kong Health Insurance plans – which tend to offer much lower coverage levels than their international counterparts.

However, in the case of your stent, this would be the most realistic option for both obtaining health insurance coverage, and insuring your pre-existing condition – if you understand that you would only receive coverage for conditions related to your heart after a minimum of two full policy years have elapsed.

During the moratorium period the pre-existing condition (and all related conditions) would be excluded from coverage under the plan – any treatment received which is not related to the condition would be coverage as normal up to the stated policy limits.

Coverage with a Loading

The final option available to individual consumers, and the least likely to be implemented in the case of a heart stent, is coverage of the pre-existing condition in return for an increased overall premium payment.

Essentially, if the insurer offers this option you can expect the policy to cost significantly more than it would normally. Unfortunately, coverage under a loading is generally only offered for conditions like Asthma and not in surgical cases.

Coverage with Medical History Disregarded

The only true way to ensure full coverage of a pre-existing medical condition is through the purchase of a policy which offers a Medical History Disregarded (or MHD) benefit.

MHD is normally only offered to businesses and larger groups where at least 5 people, who are not related to each other unless they are a contracted employee of a family office, are covered under the same health insurance plan.

In the case of MHD products pre-existing conditions are deemed to, essentially, not exist. Your previous medical history would be disregarded under the plan and all treatment you were to receive through the policy would be covered up to the standard limits.

Unless you are participating in a large corporate group it is unlikely that this option would be available to you.

   

With the case of your heart stent the most reasonable solutions would be either Excluding the stent and all related conditions from coverage, or purchasing a policy which offers a moratorium option. In any event, while the stent (and related conditions) may not be insurable under a health insurance plan, any treatment which is not related can be covered with the usual array of policy options – including outpatient treatment and dental cover.

If you have any further questions about insurance coverage for your pre-existing medical condition please Contact a CCW Global Broker today. We would be happy to assist you in answering any additional queries or concerns you may have.

Answered on: 8 March, 2018 16:29


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