Do I have to be in good health to apply for health insurance?

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Do you know what counts as a pre-existing condition according to health insurance companies across Canada? Do you know what health insurance you can get if you have one?

Health insurance helps pay for out-of-pocket healthcare expenses not covered by our government health plan — and that’s vital to protecting your finances.

But if you have a pre-existing health condition before you put your health insurance in place, there is a chance that any fees incurred as a result of the condition would be ineligible for reimbursement by your plan — unless you select a plan that can help you cover that condition.

Do you have a pre-existing condition?

A pre-existing condition is a health condition that you are aware of having before purchasing a health insurance policy, for which you would have experienced symptoms or sought medical attention in the past. Regardless of the diagnosis, your insurance provider will need to know about the visit(s) in case the symptoms you were asking about develop into something that will need more medical attention.

Pre-existing conditions can range from high blood pressure to past instances of cancer. Usually, if you are still experiencing symptoms or are being treated for a pre-existing condition, any treatment in relation to it will not be covered, but health insurance plans vary.

Your pre-existing condition is not something you should omit from your application, as that is a fraudulent act and will void your policy. It’s much better for everyone if you tell the whole truth and leave nothing out.

Can You Apply for Health Insurance?

Yes! A health insurer needs to know about your pre-existing condition so they can determine what the risk is to insure you. When you have a condition that requires a lot of treatment, it costs more for the company to keep you covered. This is why some plans require you to fill out a questionnaire about your health.

Don’t worry; having a past (or present) health condition will not necessarily prevent you from having coverage. Many of the plans that have a pre-existing condition clause will allow coverage, but only for medical conditions diagnosed after your plan is in effect.

Your insurance company will decide if you can get coverage for a pre-existing problem, but in some cases, you may have higher insurance premiums to pay every month, or you may be limited to a certain kind of plan.

Everyone qualifies for a guaranteed acceptance plan

If you have had group health insurance benefits provided by an employer, you probably never had to worry about having a pre-existing health condition. Individual plans are not dependent on an employer – once you put a plan in place, it is yours for your lifetime regardless of changes in your employment or health.

If you are coming off a group health plan, the good news is that you can apply within 60 or 90 days of leaving the group and qualify for a guaranteed acceptance individual health insurance policy.

If you haven’t had group benefits in place, don’t worry. There are a wide range of “guaranteed issue” health insurance plans available that accept all applicants regardless of your medical history. You will not be required to have a medical exam or fill out a questionnaire in order to qualify.

You can apply for other fully underwritten health insurance plans

You can apply for coverage with a plan that does not offer guaranteed acceptance. If you have a pre-existing condition, your qualification for coverage may be more difficult to get, but that doesn’t mean you shouldn’t try.

A non-guaranteed acceptance plan (also known as a fully underwritten plan) will require that you complete a medical questionnaire. Once it’s completed, the insurance carrier will look at what pre-existing condition(s) you have, the plan you wish to purchase, and will then determine whether they will offer you coverage.

Depending on your condition, you may be eligible for coverage, but with exclusions. This means that any services or items related to your pre-existing condition will be excluded under your plan, but all other eligible treatments for ailments not related to your condition will be covered.

For example, if you have pre-existing diabetes, your coverage may have an exclusion like this:

  • Insulin will not be covered
  • Needles, test strips, will not be covered
  • Medications in relation to diabetes are not covered
  • Any other eligible services that are NOT related to diabetes are covered.

If your pre-existing health condition application is turned down and you don’t qualify for coverage, you can always then apply for a guaranteed acceptance plan.

Don’t put it off. Make sure you have a health insurance plan.

It can be overwhelming to shop for a health insurance plan. There are many things to consider – different options and lots of different conditions attached to them. If you have a pre-existing condition it can seem doubly intimidating, but there’s nothing to fear. Just be certain to familiarize yourself with the terms of the plans you are looking at.

And, if you are leaving a previous policy, make sure that you start looking for another plan immediately. This will improve your chances of finding (and qualifying for) the perfect plan for you.

We can help

Don’t let a pre-existing medical condition stop you from applying for insurance. Call us at SBIS today and our customer service representatives can work with you to find out what you need and review your options. Or go online at SBIS Health Insurance. We are experts in health insurance and will help you find the best plan for you.


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