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Health Insurance With a Pre-Existing Condition

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Did you know that pregnancy counts as a pre-existing condition, according to health insurance companies across Canada? If you are expecting a baby and purchase a health insurance plan during gestation, there is a chance that any fees incurred as a result of this pregnancy will be ineligible for reimbursement by your plan.

For example, if you purchased a plan six months into your pregnancy and require Pregvit vitamins or hospital accommodations, your plan will not cover the costs if it has a pre-existing clause.

If you are coming off a group plan and go into a guarantee issue plan, your pregnancy would be covered. Every plan is different. It’s important to know the facts about clauses such as this, so you can be prepared should you encounter any difficulties with your claims.

What is 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 for in the past. Regardless of the diagnosis, your insurance provider will need to know about the visit 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 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.

What Are the Implications?

The reason insurance companies need to know about your pre-existing condition is 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 such a 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.

The insurance company will decide if they will take you on as a client. 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.

Guaranteed Acceptance

If you originally had a health insurance plan through your employer, you probably never had to worry about the pre-existing conditions clause. But let’s say you retired or were no longer eligible for benefits under that plan. You would then need to purchase one for yourself, which would in theory be new territory for you.

If you are coming off one plan and trying to get another, one thing to watch for is that some plans will require that you apply within 60 or 90 days of leaving the group plan for guaranteed acceptance. On top of that, you will have to find out if the pre-existing conditions limitations will apply to the plans you’re thinking of purchasing. If you are moving from one individual to another plan, there may not be as many choices, or high maximum options offered.

It’s important to get as much information as possible about the plans you’re looking at. When you do your research, you might find that a guaranteed acceptance plan is ideal for your case. These types of plans will cover you regardless of your medical history. You will not be required to have a medical exam or fill out a questionnaire in order to qualify.

These plans will still have eligibility requirements, such as the maximum time period between coming off a group plan and purchasing the new one, and some may only be available to those who had previous coverage. If you speak with an insurance broker, they will be able to give you all the information you need in order to make a decision, as well as assist you in purchasing the plan.

Non-Guaranteed Acceptance

Another route you can explore is to 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 will require that you complete a medical questionnaire and once it’s completed, the insurance carrier will look at it carefully and determine whether or not you will qualify. They will look at what pre-existing condition(s) you have, the plan you are wishing 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 will look 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

Another thing to consider is that the non-guaranteed acceptance plan may not accept you at all based on your medical questionnaire. In this case, it’s recommended that you pursue a guaranteed acceptance plan. You may get a counter-offer with a plan that you actually qualify for.

Purchasing 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.

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.

Avoiding Surprises

Familiarize yourself with the terms of the plans you are looking at. If you call us today, our customer service representatives can work with you to find out what you need and review your options. They are the experts in the field, and will help you find the best plan for you.

An insurance broker can make sure that your needs are addressed and that you don’t have any surprises when the time comes to file a claim. Our brokers are your allies and can advocate for you. Don’t let a pre-existing medical condition stop you from applying for insurance. We can help you today; all you need to do is call.

36 Responses

  1. Hi,

    We are planning to move to Canada next year as permanent residents. I have a pre-existing condition and need to find out what my options are when we get there. Please put me in touch with someone that can help me with some of the questions. We currently have health insurance without any exclusions but this is not within Canada so not sure if it ‘counts’.

    Cheers,
    Yolanda

    1. Hi Yolanda,

      Thank you for your inquiry. We’ll have an agent reach out to you during regular business hours to discuss your options and answer all your questions about our health insurance products.

  2. I need advice for travel to Mexico from Ontario with a pre-existing health condition that has been stable 9 months. I still see a specialist every 6 months.

    1. Hi Dorothy. Give us a call at 1-800-667-0429 as we would need more detailed information to provide you with the most accurate quote.

  3. I am 2 months pregnant right now, and planning to move British Columbia in February. By then I will be almost 4 months pregnant. What type of health insurance covers the expenses of my pregnancy?

    1. Hi Arti. The Guarantee Issued plans typically cover pre-existing conditions such as pregnancy and pregnancy related issues. Plans we offer such as the Green Shield Prism Continuum and the Manulife FollowMe plans would fall under this category. These plans do require you to be coming off a company group plan though. Provincial healthcare is required before you would qualify for any individual health and dental plans as well. Please give us a call to discuss.

  4. I recently found a new job that is offering a group benefit package. I have remitting relapsing MS, but have been very stable for a long time. The meds I am on, are pain meds for nerve pain. My benefit application did not ask anything about about pre-existing conditions I have or my husband. Will I have I issues getting my meds partly paid for. I have had 2 different plans with my condition and was never denied coverage before. How do I check before my other plan is cancelled. The pharmacist told me to check, in case I need to cancel my new work and buy a guaranteed insurance package?

    1. Thank you for your questions. We here at SBIS, do not provide company group benefits, we specialize in individual coverage after you leave your group. This means to have your questions answered about your current group plans, you would have to speak to either your Human Resources department or speak directly to the insurance company that is in charge of your group plans. Sorry we can’t be of more assistance.

  5. Good day, I have been unemployed since my company went bankrupt 2 years ago. I was unaware that I could apply for a plan immediately after we were let go so my insurance lapsed. After 6 months { 1 & 1/2 years ago } I got Health Insurance coverage from Blue cross. However as I have Type 2 Diabetes { under control and have not need Metformin for over a year } as well as Myasthenia Gravis { I take Mestanon and will probably have to take it for my lifetime } Blue cross refused to cover any drugs or treatment for either condition. My question to you folks is, DO YOU HAVE A PLAN THAT WOULD COVER ME FOR THESE DISEASES?

    1. Our Group conversion plans are only available within 90 days of losing your Group benefits. The other plans we offer are medically underwritten and would exclude your pre-existing medical conditions. We also offer Manulife that has for the past two years offered an OPEN Enrollment period for a specified time. Unfortunately the open enrollment closed as of December 6, 2018. I would suggest you check back with us later this year (November) to see if Open Enrollment is offered for 2019.

  6. I have a heart condition and I am being treated with medication with no insurance. Could I get insurance to cover this cost?

    1. Our Group conversion plans are available within 90 days of losing your Group benefits and do cover pre-existing conditions. If you have not been covered by a group plan, the other plans we offer are medically underwritten and would exclude your pre-existing medical condition. We offer Manulife that has for the past two years had an OPEN Enrollment period for a specified time. The Manulife Follow-Me Plan will cover your pre-existing condition. Unfortunately the open enrollment closed as of December 6, 2018. I would suggest you check back with us later this year (November) to see if Open Enrollment is offered for 2019.

  7. I am looking for a plan that would cover my son who was just recently diagnosed with MS. Would his medication be covered?

    1. Thank you for your comment. There are a lot of variables that go into that question. It’s best that you give us a call to discuss your situation with one of our knowledgeable customer sales representatives at your convenience Monday to Friday 8:45am-4:45pm Eastern Time. We look forward to assisting you.

  8. Our daughter is a disabled Canadian citizen returning to BC and needs medical coverage for the 3 month waiting period. Is there a plan available to cover her with her disabilities?

    1. Hello,

      In response to your question we offer Destination Canada Visitors to Canada coverage for returning Canadians awaiting Provincial Health Care coverage that will cover pre-existing conditions that were stable for 120 days prior to the effective date.

      The plan will cover emergency illness and accidents up to the maximum chosen $10,000.00 – $300,000.00 CDN.

      Stable means:

      Stable means a pre-existing medical condition that:
      a) did not require, or was not referred for any medical consultation;
      b) did not require a change in type of dosage of medication;
      c) did not exhibit any signs or symptoms

  9. Hi, I need health insurance as the last one expired. I have a pre-existing condition . Can you please connect to discuss the options? Thank you

    1. Thank you for your comment Mak, we will have one of our knowledgeable customer service agents reach out to you shortly.

  10. We are 4 males (61, 59, 57 and 75) currently living in Canada and intending to move to Mexico. The 59 year old has a preexisting conditin in that he had a double transplant (liver pancreas) in 1999. He is in stable condition and in good health however we would need insurance in case he needs hospitalization. PLeae contact me either at 403-231-4330 or by email. Thank you
    Drew

  11. Hey. With an international student visa, I will be arriving in British Columbia at mid-April with a seventh month pregnant, considering three months for MSP coverage. Could you tell me if there is insurance coverage for the delivery of the baby ?

    1. Thank you for your question. We do not offer any plans that cover pregnancy related procedures as a Visitor to Canada. The only way to receive coverage would be getting the provincial healthcare (MSP) before you have the baby, or having the baby in your home country.

  12. I am looking for insurance for pre-existing medical condition. Right now I am covered under my husband’s company insurance but he is retiring at the end of March and we will not have any more benefits as of that date.

    1. Thank you for your message. We have over a dozen different plans that would cover pre-existing medical conditions when coming off a group plan. I will send you a direct email to connect to speak to you about your options.

  13. Hi Gavin. Can you reach out to me about plans for health insurance after I have left my employment in March of this year.

  14. I am temporarily moving to Canada to study and need health insurance. I have one included in my tuition costs but I beleive they don’t cover pre existing conditions, what insurance can I get to address my needs?

    1. Thank you for your question. We do have a number of different plans that may suit your needs. We will reach out to you directly to assist you.

  15. I am a student in canada and have a pre-existing condition which will not be covered in student’s medical insurance. Can you please help me in this case? What option I have?

    Regards,
    Namrata

    1. Thank you for your comment. We will have someone reach out to you directly through email to get a few more details of your situation and provide the best assistance we possibly can.

  16. I’m an international student with a pre-existing medical condition. Is it possible to get any health insurance plan with your company?

    1. Thank you for your question. I will have our International Student specialist reach out to you directly via email with some options to your situation.

  17. Hi, I’m planning to go to Canada in April but I will be six months pregnant by then. Please share the policies available that would cover the entire cost of childbirth. Thanks

    1. Thank you for your question. I wish we had a better option for you, however as you are already pregnant and do not have Provincial healthcare coverage in Canada we are unable to offer you any coverage for your pregnancy. We do have a Visitors to Canada Insurance option however that would cover emergency accidents and illnesses only.

  18. I am currently coved as couple with Greenshield but it’s become to expensive. If I cancel we need to find coverage for one person with pre-existing conditions, it’s mainly prescription drugs we are worried about. Are there any conditions not covered

    Debbie Kaser

    1. Hi Debbie, thank you for your comment/question. As each situation is unique, it’s best to give us a call if you can to discuss. Please call 1-800-667-0429 so we can guide you with a few different options for you.

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