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If you’re looking to purchase life insurance and you have a medical condition that significantly impacts how you live, there’s a good chance it will be classified as a pre-existing condition.

While having a pre-existing condition may influence your premium rates, and may exclude you from coverage by some providers, the notion that you are uninsurable is a common misconception.

What is a pre-existing condition for life insurance?

Pre-existing conditions are generally classified as any medical conditions you have or have had before purchasing a life insurance policy. This could be a medical condition that requires ongoing treatment, one that has required treatment in the past, and in some cases, even conditions that have been successfully treated.

Life insurance providers need to know about your medical conditions because they impact the level of risk posed to the insurer by covering you. For example, someone who has previously had cancer could be seen as a higher risk to insure, since they are more likely to claim than someone who doesn’t have a pre-existing condition. As a result, they might have to pay a higher premium (or “loading”) than a person without that condition, for the same policy.

It’s important to note that each insurance provider may have differing policies. Some may not consider a medical condition a pre-existing condition if it no longer requires treatment or occurred more than a certain amount of time ago. Some providers exclude pre-existing conditions altogether.

For this reason, it is important to determine what different providers take into consideration when it comes to defining what is a “pre-existing condition” for the purposes of the policy, and whether or not they will pay claims for events related to the pre-existing condition.

What could be considered a pre-existing condition?

Essentially, any condition you currently have or previously had that affects your health, and could potentially result in a claim, could be classified as a pre-existing condition. General examples of pre-existing conditions are:

  • heart disease;
  • high blood pressure;
  • musculoskeletal conditions;
  • stroke;
  • cancer;
  • depression/anxiety;
  • sleep apnoea;
  • kidney or liver disease;
  • diabetes; and
  • many more.

In some cases, medical conditions you had in the past may not be considered pre-existing conditions under your life insurance policy. These can include conditions that were successfully treated and no longer require medical tests, or conditions that haven’t required treatment for a specific period of time.

Definitions regarding pre-existing conditions can vary, so it’s always worth reading the Product Disclosure Statement (PDS).

Does life insurance cover pre-existing conditions?

In many cases, you will find certain life insurance policies will cover you even if you have a pre-existing condition. However, your provider may increase your premium with a loading as a result.

If you are looking to get life insurance with your pre-existing condition covered, you may have to provide copies of medical reports or, undergo a medical examination. This can help prove the extent of your condition.

Whatever your pre-existing condition may be, one good way to find the most suitable cover for you is to shop around and compare policies, since coverage varies depending on the provider.

What should I do if I have a pre-existing condition?

Determine what you need covered

To get the most out of your policy, you should make a personal checklist of what conditions you need coverage for. Make sure you include anything that affects the way you live and could potentially impact your ability to work.

Shop around

Just because one life insurance provider might not cover your pre-existing condition, it doesn’t necessarily mean you’re uninsurable. We offer products from a range of insurance providers, so shop around until you find a policy that’s suitable.

Be honest when applying

Life insurance customers are bound by a duty of disclosure. While having a pre-existing condition may increase your premiums, not disclosing your medical condition can be even more costly. You may have your claim denied if you do not tell your insurer the truth about your medical history when you apply, meaning you would have paid premiums for a policy that doesn’t cover you properly.

Provide as much information as asked

The more information you provide, the more your insurance provider can tailor your cover to suit your requirements and potentially save you money on premiums. A pre-assessment can also help your provider gain a better understanding of your current condition and give an early indication of whether they are likely to be able to offer you cover or not, before you complete a full application.

What is a life insurance pre-assessment?

A life insurance pre-assessment is a process that can help you gain a better understanding of what policies may be available to you. This is generally done through an insurance consultant, before you purchase a policy, to give you an idea of which life insurance policies could cover your condition.

It involves a form that asks questions regarding your pre-existing conditions, along with your general details (age, height and weight), and other information regarding your current lifestyle. This form can usually be filled out over the phone by your insurance consultant. The more information you give, the more comprehensive the pre-assessment can be.

Pre-assessments are not compulsory, but your insurance consultant may request you to complete one if you have a pre-existing condition.

What information will be gathered during the pre-assessment?

 

Date of birth, height, and weight.

Do you drink or smoke? Regular consumption of alcohol and cigarettes can affect your health, so disclosing this information helps providers determine whether they are likely to offer you cover, and on what terms. Also, any hobbies, work activities, or pastimes you participate in could impact your policy, particularly if they’re considered high risk (e.g. diving, extreme sports).

Any information about current conditions should be disclosed.

Any significant medical conditions you have been treated for in the past should be disclosed. With each insurance company having varied parameters when it comes to pre-existing conditions, detailing your health history can help the consultant to see if they can identify a particular provider whose parameters you may be able to fit into.

Medical conditions that run through your family could also help determine an insurer’s decision. For example, if you have family history of diabetes, this information could help your insurance provider determine how likely you are to be diagnosed during your life.

It’s important to note that the results of your pre-assessment aren’t guaranteed, but they should provide you with an idea of what kind of cover and prices you can get. If you cannot be covered by a standard policy – due to your pre-existing condition or other factors – your life insurance provider may indicate that they might offer a policy with revised terms. Revised terms may include:

  • Loadings: You would be able to receive the usual policy benefits, but at an increased premium due to loading. A loading might be added onto your premium if you have a pre-existing condition like diabetes or if you’re a smoker.
  • Exclusions: Certain benefits may be excluded from your policy, due to your pre-existing condition or other circumstances. For example, if you have a heart condition, benefits based on heart attacks might be excluded.

Case study

Gary had a heart condition 10 years ago that required open heart surgery. He still requires medication, but lives a healthy lifestyle with a proper diet and regular, low-impact exercise.

While there are other insurance companies that can insure him, Gary’s provider has excluded claims involving heart disease. So if he died of heart disease, his beneficiary would not be able to claim on the policy.

For better coverage, Gary could complete a pre-assessment with a consultant to determine which provider could offer him a new policy that covers death due to heart conditions.

What are common exclusions in life insurance policies?

While you may be able to find a life insurance provider that can cover your pre-existing condition, there are some things that most companies will not cover. Common exclusions include:

  • Self-inflicted injuries and suicide: A lot of policies won’t pay claims for death resulting from self-inflicted injuries and suicide within the first 13 months.
  • Reckless behaviour: Claims based on injuries/death from reckless activities such as dangerous driving, or anything else where safety precautions and warnings were disregarded, may be excluded from your policy.
  • Criminal activity: If a claim is made based on an injury or death that occurred while committing a criminal activity, it may not be covered by your policy.

Other exclusions for specific policies may also include:

  • Life insurance: You may not be covered for claims that arise in countries that have a “do not travel” warning. You can find out which countries have this warning on Smart Traveller.
  • Trauma cover: Within the first 90 days, some trauma events such as heart attack, stroke and cancer may be excluded. Low grade, generally non-life-threatening cancers may also be excluded.
  • Total and Permanent Disability (TPD) cover: Given the name of this policy, temporary injuries and disabilities are usually excluded.
  • Income protection: Pregnancy-related ailments may be excluded from income protection policies, provided it is a regular pregnancy without complications. This may include morning sickness, post-natal depression, and back problems.

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