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If you’re looking to purchase life insurance (also known as term 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 or even 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?

It’s important to note that each insurance provider may have differing policies. Some may not consider a medical condition to be pre-existing if it no longer requires treatment or occurred some time ago (e.g. 10, 15 or 20 years). Then again, some providers may exclude pre-existing conditions from cover altogether.

For this reason, it’s important to determine what different providers take into consideration when it comes to defining a condition as pre-existing for the purposes of the policy, and whether they will pay claims related to the pre-existing condition.

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

Life insurance providers need to know about your medical conditions because it can impact the level of risk posed to them 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 suffer from the same condition or a similar condition further down the line than someone who doesn’t have a pre-existing condition. As a result, they might have to pay a higher premium (or ‘loading’) for the same policy than a person without that condition.

What could be considered a pre-existing condition?

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

  • Heart disease
  • High blood pressure
  • High cholesterol
  • Musculoskeletal conditions
  • Strokes
  • Cancer
  • Mental health conditions (including depression and anxiety)
  • Sleep apnoea
  • Kidney or liver disease
  • Diabetes.

In some cases, medical conditions you had in the past may not be considered pre-existing 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 time.

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

How 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 medical condition. However, your provider may increase your premium with a loading as a result to account for the added risk of insuring you.

If you’re looking to get life insurance with your pre-existing condition covered, you may need to provide copies of medical reports or undergo a medical examination to satisfy the underwriting guidelines for the insurer to accurately determine the level of risk involved if they insure you (underwriting refers to the process where an insurer accepts a contract to insure a customer).

Whatever your pre-existing condition may be, a 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

Like with most types of insurance, you are bound by a duty of reasonable care not to make a misrepresentation when taking out a life insurance policy. 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 provider the truth about your medical history when you apply, meaning you would have paid premiums for a policy that may not cover you.

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 can offer you cover 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 about your pre-existing conditions, along with your general details (e.g. age, height and weight) and other information regarding your current lifestyle and occupation. 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?

The information you may need to provide can vary between providers but may include the following types of information.

  • General: Date of birth, gender, height, weight, home address and personal contact information.
  • Lifestyle: Smoking status and average alcohol consumption, hobbies, work activities, extreme sport or pastimes you participate in.
  • Health status: Information about pre-existing conditions, former surgeries and any information about current medical conditions.
  • Family history: Any family history of health issues or medical conditions, including the current and former health status of your parents.
  • Occupation: What is your current occupation and the requirements of your role, and what industry or field you work in.

It’s important to note that the results of your pre-assessment aren’t conclusive; rather, they’re a guide to give you an idea of what kind of cover and prices you can get. If you can’t be covered by a standard policy due to your pre-existing condition (or other factors), your life insurance provider may offer a policy with revised terms tailored to your needs. These terms may include:

  • Loadings. You would still receive the usual policy benefits but at an increased premium due to loading. A loading might be added on to 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 this cause, his beneficiary would not be able to claim on the policy.

Gary could search for better coverage, by completing a pre-assessment with Compare the Market to get an idea of whether another provider could offer him a new policy that covers death due to heart conditions.

What are some 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 many providers 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 of cover.
  • Reckless behaviour. Claims for injuries or death caused by reckless activities (like 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 for an injury or death that occurred while committing a criminal activity or breaking the law, 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 if you’re in a country that has a ‘do not travel’ warning. You can find out which countries have this warning on Smartraveller.
  • Trauma cover: Within the first 90 days of cover, some trauma events (such as heart attacks, strokes 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’s a regular pregnancy without complications.

You should always read the Product Disclosure Statement (PDS) to understand the exclusions and limits that are applicable to any policy you are considering.

Frequently asked questions

Will I pay more for life insurance if I have a pre-existing condition?

You’ll likely pay more for life insurance with a pre-existing condition, which is known as a loading. However, it’s important to keep in mind that there are a wide variety of other factors that can affect how much you pay for life insurance, including:

  • Your occupation
  • Whether you participate in high risk hobby or sport
  • How much alcohol you drink
  • If you smoke cigarettes or cigars.

Do I need to have a medical exam to get life insurance?

Some providers will require you to have a medical exam with a doctor or medical professional if you want to get life insurance, but not all of them will have this requirement. You’ll still need to fill out a medical questionnaire regardless of whether your provider requires an actual medical examination or not.

How do I get life insurance with a pre-existing condition?

It’s still possible to get life insurance if you have a pre-existing health condition. You can get life insurance by:

  • Buying it directly from a life insurance company
  • Getting it through a broker
  • Purchasing it with the assistance of a financial adviser
  • Taking it out through your superannuation fund

You’ll need to fill out the provider’s questionnaire and tell them about your condition. While you may have to pay a premium loading or face exclusions specifically related to your condition, you can still take out life insurance and get cover for yourself and your family.

What happens if my life insurance application is declined due to a pre-existing condition?

If an insurance provider denies your application for life insurance based on their eligibility criteria, you have a couple of options:

  • Contact the provider to ask why
  • Request a copy of the information relied upon to decline your application for cover
  • Lodge a formal complaint with the Australian Financial Complains Authority (AFCA)
  • Try purchasing life cover with another provider

Do I have to disclose all my personal information to take out life insurance?

You’ll need to disclose a certain amount of information requested by the provider as part of the application process. Failing to give them this information can be seen as a non-disclosure, which can impact your ability to get insurance coverage.

Insurance companies have strict policies to protect customer privacy and sensitive information, so you don’t need to worry about disclosing your information.

Will I lose my life insurance if I develop a health condition later on in life?

Should you develop a health condition after you take out life insurance, you will still be covered. You’ll need to contact your insurance provider to inform them of the diagnosis, and this may affect loadings or condition-related exclusions.

Will my life insurance premiums change if my condition improves?

If you recover or are able to reduce the impact of your condition, your premiums may not necessarily decrease. This is because having a medical condition, regardless of whether it was temporary, means you may be at a higher risk of having health complications later in life.

Additionally, life insurance progressively gets more expensive as we age, partly due to the higher likelihood that you’ll need to make a claim as you get older.

Executive General Manager of Health Life and Energy

Tips on life insurance pre-existing conditions from our Executive General Manager of Health, Life and Energy, Steven Spicer

  1. Always be honest with life insurance providers when it comes to pre-existing conditions. While a pre-existing condition may raise your premiums or mean certain life insurance providers can’t cover you, failing to disclose medical conditions could mean your claims get denied or you’re paid significantly less.
  2. Provide as much information as you can about your medical conditions when searching for life insurance. This will let you know early on if your pre-existing condition can be covered or if you should seek cover with a different provider.
  3. While not compulsory when taking out life insurance, consider completing a pre-assessment, as they can help you better understand which policies are available to you. Pre-assessments gather information around your lifestyle, health history, health status and more to give an idea of the kind of policies that may suit your needs.

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Ready to compare your options? Our free life insurance comparison service compares polices from a range of providers to help you find cover. You can compare all the features, benefits and prices of life insurance products in the one place, and all for free!

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