Compare direct brands with a medical questionnaire upfront
Before using an adviser
An adviser will take your condition into consideration when getting you a quote. Your adviser will then need to speak to an underwriter (the person who creates the policy) in order to get you cover. There may be some back and forth before cover is actually finalised.
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Pre-existing conditions: Key tips
If you have a pre-existing condition, there's a few things we recommend to have a better chance if you need to make a claim later on.
Here's what you need to know:
Beware of policies with no medical questionnaire
If you apply for a policy that has no medical or lifestyle questionnaire or one that is automatic acceptance then understand:
These policies will automatically exclude your pre-existing medical condition.
Our recommendation: Go for a policy with a medical/lifestyle questionnaire or use an adviser if unsure about exclusions. It might take longer but there's less surprises when you claim.
Understand what happens after you apply
Depending on the nature of your condition, life insurers will typically either:
Automatically cover the condition
Request additional information about the nature of the condition
Exclude the condition from being covered
Be careful when changing or increasing cover
If you decide to switch providers or try to increase your cover there is a chance where you won't be covered or have limited cover.
If you switch providers. Check with the new provider if your condition will be covered first.
If you increase your cover. See if they will make you do another another medical questionnaire - this might void your cover. You may also not be able to claim in the first year of your sum insured being increased.
by Maurice Thach
Life Insurance Publisher for finder.com.au
Should I use an adviser?
I recently sat down and spoke to financial adviser Andrew Kennedy to find out more about the benefits of using an adviser. Here are the main takeaways:
1. An adviser can help you disclose correctly
While we all worry about failing to disclose information to an insurer, it's also common for people to over disclose. Although you may be unsure if something is relevant or not, an adviser will be able to find out for you.
For instance, Andrew dealt with a client whose specialist made a comment that his prostate was enlarged and that this was common for men his age. Andrew found out that, because there were no recommendations for follow up testing, there were no issues to disclose.
Using an adviser can help you get standard rates in situations where you may otherwise get yourself policy exclusions.
2. Advisers compare a bunch of insurers for you
Advisers can also take your medical history to potential insurers and find you the best possible rate. Before putting your application through, they'll be able to find out if any of your pre-existing conditions will cause any issues.
It may take a little longer to go through an adviser, but the result is you'll have more certainty when it comes time to claim. If you'd much rather go direct, use an insurer that's "fully underwritten" like NobleOak Life Insurance.
Why is "underwriting up-front" important
Not all insurers treat pre-existing conditions in the same way.
If you have a pre-existing condition, chances are you'll want an insurer that can be up-front with you about whether they will end up actually covering it or not. Otherwise, you're just flying blind and that's not helpful for anyone. How insurers factor pre-existing conditions into their policies comes down to their underwriting process – ie, the process they use to work out an applicant's risk.
You'll find that they handle the underwriting process in one of three ways:
Some policies, especially those you buy direct from the insurer, usually don't do underwriting on an individual basis. This means they will most likely exclude all pre-existing conditions, otherwise they'd be opening themselves up to all sorts of expensive claims from their most risky customers.
This type of cover is convenient to buy and is perfect for someone healthy who just wants to get up and running with minimal fuss. But it's not the best choice for someone with pre-existing conditions, because insurers offering this cover will often have the right to exclude your condition even if they didn't ask you about it when you signed up.
If you have pre-existing conditions (even ones that have cleared up) or you're uncomfortable with the lack of transparency with this type of arrangement, you'll probably want an insurer that will underwrite your policy specific for you.
Insurers that perform full underwriting take the time to understand your specific life stage and health circumstances to structure a policy specifically tailored to you. They may or may not decide to cover your pre-existing conditions, but you win either way.
If they don't cover them, you're likely to pay less for the policy. If they do cover them, you get the benefit of cover, albeit at a higher rate. Another major benefit is that you get to know up-front what you will and won't be covered for. This type of policy is perfect for someone who wants transparency and a sense of confidence going into the claims process. You'll usually need to go through a broker or adviser for one of these policies.
Even if an insurer is up-front and transparent with you about excluding your pre-existing condition from cover, that doesn't mean you'll be satisfied with the decision. You might be left wondering:
Why is your condition excluded?
How long must you have gone without symptoms before you can add the condition back into your policy?
Is there a way to get re-evaluated?
That's where 'Full underwriting with next steps' comes in. Not many insurers feel comfortable going into this level of detail, but one insurer – TAL – has developed a new system that does just that. This insurer is giving its advisers training relating to the most common pre-existing conditions so that they can explain to clients how they factor the pre-existing condition into their underwriting process.
The program also educates clients on how to manage and treat their conditions, and may even offer a roadmap that explains when the insurer might re-evaluate their decision to exclude it.
Policies that offer this level of transparency are for people who not only want to know what's going on, but who want to be part of the process, and would like their future options as clear as possible.
Generally speaking, it’s a medical condition you had before you took out your life insurance policy which could have an effect on the likelihood that you will need to make a claim.
However, things get a little more complicated when you discover that there’s no uniform definition of a pre-existing condition used by all insurers. Instead, each insurer defines pre-existing conditions in its own way.
There’s no uniform definition of a pre-existing condition used by all insurers
Unique definitions: This is where it gets complicated
Some providers will exclude all pre-existing conditions from cover altogether, even though you may not have required any treatment for a health problem for decades.
Meanwhile, if your health problem has been successfully treated and doesn’t require any ongoing medication, tests or consultations, other insurers will define it as no longer being a pre-existing condition at all. When this occurs, your condition won’t have any impact on your ability to access cover.
However, the waters get even murkier when you realise that other life insurers will cover a pre-existing condition if you stopped requiring treatment for it over a specific period of time. Depending on the insurer, this time period could be 6 months, 1 year, 2 years or even 5 years.
Defining pre-existing conditions can be complicated, but let's keep it simple. Here is a general way to understand it:
Is my issue considered a "pre-existing condition" by an insurer?
Various conditions that fall into this category include heart disease, asthma and diabetes. Here are some general considerations for pre-existing conditions:
Not a pre-existing condition due to successful treatment. Most life insurers will consider a condition not pre-existing if it was treated successfully and requires no further exams or tests.
Not a pre-existing condition due to time. Some insurers may categorise a condition as not pre-existing if treatment has concluded for a specific time period.
It is a pre-existing condition. A life insurance term that means all pre-existing conditions are automatically excluded, no matter how much time has elapsed since you last required treatment.
Note: When applying for life insurance you are required to disclose details of any pre-existing conditions at the time of application. Failure to do so may result in your claim being rejected.
I have a pre-existing condition. Will an insurer accept my application?
If your condition is considered a pre-existing condition the insurer may ask for some more information, eg further medical reports, evidence of treatment, family history.
Once the insurer has enough information
An insurer is likely to:
Accept the application and apply a premium loading
Accept the application and exclude that condition from cover
Reject the policy application
Note: If it's not clear how your condition will be treated from the information on the insurance website or in its product disclosure statement (PDS), make sure you contact the insurer or speak to an adviser before applying.
Important exclusions to understand
There is a range of other general situations and conditions that are usually excluded from cover, depending on the type of life insurance.
Suicide within the first 13 months after taking out a policy
Visiting an overseas country in the first 12 months of cover when the Department of Foreign Affairs and Trade has issued a “Do Not Travel” warning for that country
Income protection insurance
Self-inflicted injuries or attempted suicide
Any injuries caused by war
Normal pregnancy and childbirth (eg morning sickness, bladder issues, post-natal depression)
Cancer, heart attack and stroke in the first 90 days of cover
Suicide within the first 13 months after taking out a policy
Self-inflicted injuries or attempted suicide
Low-level cancers, such as basal cell carcinomas
Injuries or disabilities that are not considered to be permanent
What information do insurers use to review policy applications?
Family medical history. Details of any medical conditions suffered by immediate family (eg mother, father and siblings) including mental disorders, diabetes, cancers and heart disease.
Medical history. Details of any medical examination, consultations, procedures or medications (including stimulants or sedatives taken within the last five years).
Lifestyle. Whether you are a smoker, have a history of alcohol abuse or are currently taking any prescription or non-prescription drugs.
Your occupation. The profession you work in, the hours, your title and the size of the company that employs you are all important factors for insurers.
Your financial situation. Your insurer will want to make sure that they are not over- or under-insuring you and that you will be able to keep up with the required premium repayments.
Your participation in hazardous pursuits. Insurers may take into account your participation in hazardous pursuits, such as skydiving or mountaineering, as well as your level of competency in these activities.
If you are not sure of any of the details listed above, you should contact the relevant people to clarify or obtain the necessary information.
What happens if I fail to disclose a pre-existing condition?
In the event of a claim, an insurance provider will take rigorous steps to review the policyholder's medical history and contact the medical professionals from whom the claimant had received treatment or care over the years.
If it is found that the claimant withheld details about their, or an immediate family member's medical history, the claim may be rejected if the condition is found to have impacted the claim. According to ASIC Report REP 498 Life insurance claims: An industry review, 2016, about 5% of claim disputes in Australia are caused by non-disclosure of health-related information.
Debunking life insurance myths about pre-existing conditions
There are some common myths about pre-existing conditions that have misled people into thinking they cannot get cover from life insurance providers. Some of the common ones include:
I am uninsurable. This is the biggest and most popular myth of them all. People who have had pre-existing conditions are led to believe that if you have diabetes or heart disease, you cannot obtain life insurance. However, the insurance industry is continuously developing its products in order to meet their clients' unique demands.
I have a special condition that is uninsurable. Here’s a fact: insurance providers may offer a wide selection of similar insurance products, but that does not mean that they have similar features, cover and limitations. If your medical condition is rejected by one insurer, it does not mean that other providers will do the same. A large number of insurance companies now exist in Australia that specialise in providing life insurance for people with high-risk jobs and/or pre-existing conditions.
I need to undergo a rigorous medical examination. This is another myth that causes a lot of people to shy away from getting life insurance. Just thinking about the series of medical tests you have to go through is enough to discourage even the healthiest person. However, if you have had a previous health condition but you see your doctor regularly, take the prescribed medication properly and have your doctor’s medical report to attest to that, you don’t need to subject yourself to another medical exam.
Steps for choosing a life insurance provider
Identify what type of cover you need. Before shopping around, it helps to sit down first and list the things you want in a policy. This includes the type of policy and the length of cover you need since this will affect the cost of your premiums.
Weigh up your options. Don't limit yourself to one provider and take the time to see what is available on the market.
Get professional help. If you are having difficulty sorting through the different policies, you can always engage the services of an insurance adviser. These specialists are able to access a large network of insurers and offer you policy options and quotes tailored to your requirements.
Be honest when applying. It is important to take the necessary steps that are prescribed by your insurance provider during the application process. Provide all necessary documentation and answer all questions related to your condition as truthfully as you can.
Are there any policy clauses to be aware of if I have a pre-existing condition?
There are some key components of your policy to look out for if you have a pre-existing medical condition and are looking to take out cover. This includes:
Any exclusions and restrictions.This is a very important area to look at if you have previous health conditions, as you need to see whether there are any restrictions with regards to the cover based on your previous health conditions. Your condition may be automatically covered or you may need to undertake additional underwriting.
The cost of the cover. Depending on any previous health conditions from which you have suffered, the cost of your life insurance cover can increase dramatically due to premium loading. In order to get the best deal possible you need to make sure you compare quotes from a number of insurance providers.
* The products compared on this page are chosen from a range of offers available to us and are not representative of all the products available in the market. There is no perfect order or perfect ranking system for the products we list on our Site, so we provide you with the functionality to self-select, re-order and compare products. The initial display order is influenced by a range of factors including conversion rates, product costs and commercial arrangements, so please don't interpret the listing order as an endorsement or recommendation from us. We're happy to provide you with the tools you need to make better decisions, but we'd like you to make your own decisions and compare and assess products based on your own preferences, circumstances and needs.
Maurice Thach is the publisher for life insurance and business insurance at Finder and has been writing about insurance for 3+ years. His is favourite question is "Am I covered for _____?". Maurice has completed a Tier 1 Life Insurance Certification and a Tier 2 General Insurance Certification under ASIC's Regulatory Guide 146. This means he can confidently provide general advice for life insurance and non-life insurance products to Aussie readers everywhere. Outside of work, you'll probably find Maurice hitting up the nearest basketball court.
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