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Shannon Lebert

It’s very common for Canadians to have one or most existing medical conditions when applying for health insurance. Under the best circumstances, navigating through the health insurance world and finding the best plan for your needs is overwhelming. If you have pre-existing health problems, however, finding a good plan can be especially difficult.


What Is a Pre-Existing Condition?


A pre-existing condition is a health issue in which you experienced symptoms and consulted a doctor before applying to join a health benefit plan. It’s important to note that the health issue will be considered a pre-existing condition even if your consultation with the physician didn’t result in a diagnosis.


Common pre-existing conditions include diabetes, asthma, and high blood pressure.


Why Do Insurance Companies Need to Know?


Many insurance companies will request access to your medical history before accepting you for coverage. To the insurance company, your medical history offers information about your risk as a plan participant.


If you have a pre-existing health issue, you are considered to be a higher risk to an insurance carrier because the company will need to cover your treatment for the condition over the long term.


How Does a Pre-Existing Condition Affect Your Choices?


Your medical history can make it difficult for you to find a health benefit plan to join. Some insurance companies will outright refuse your application for coverage because it won’t want to be on the hook to pay for your treatment.


Other times, you may be able to get coverage, but your premiums will be more expensive than they would be if your medical history was clear. You may also face strict exclusions in your plan.


Should You Omit Details?


Knowing you have a good chance of being denied coverage because of a pre-existing health problem can be frustrating, particularly if you’ve been denied time and time again in the past.


It might be tempting for you to omit details from a previous diagnosis on your application forms in order to get coverage at a lower price. Avoid this temptation at all costs. Be honest and disclose all pre-existing conditions. Failing to disclose a medical condition could void your insurance policy.


What Are Your Options?


When it comes to finding a health benefit plan when you have health problems, you have two options: non-guaranteed acceptance and guaranteed acceptance.


Some insurance companies of medically underwritten plans will request access to your medical records and will require you to answer medical questions as part of your application. Your acceptance in a plan, the premiums you’ll pay, and the level of coverage you’ll receive will be determined based on your medical history. Trying to join a health benefit plan through non-guaranteed acceptance isn’t ideal. Though it’s possible to obtain a medically underwritten plan, it will be more difficult to qualify for coverage, you may have to accept several exclusions in your coverage, and you may have to pay higher premiums to offset your risk level.


Your second option, and the most preferred under these circumstances, is joining a health benefit plan that offers guaranteed acceptance. This is the easiest and most practical option available to you. Guarantee acceptance plans automatically offer coverage, regardless of your medical history. That means you don’t have to undergo a physical exam or answer an invasive medical questionnaire to qualify for coverage.


Under a guaranteed acceptance plan, as long as you meet the eligibility requirements, you’ll receive the coverage you need. This coverage is guaranteed regardless of which health problems you’re experiencing or how many pre-existing conditions you might have.


Shopping for insurance when you have a pre-existing medical condition can be frustrating. Opting for a health benefit plan that offers guaranteed acceptance regardless of your medical history is the easiest way to get the coverage you need to maintain your mental and physical health at a price you can afford.




Shannon Lebert

Shannon is the Benefits Administrator and Medical Underwriter for HCP and HMA. She conducts research to determine plan members eligibility for higher levels of coverage and enjoys working with the hospital human resources staff to ensure their employees are informed of the unique HCP group benefit plans. Shannon loves being an HCP team member and takes pride in being detail oriented. Outside of work, she loves spending time outdoors at the cottage, backcountry camping, and biking. When not outdoors, Shannon can be found watching movies and snuggling with her dog.
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