How do I find the best policy for my pre-existing medical condition?
There's no one particular policy that's best for anyone with a pre-existing medical condition. However, you may be able to find quality cover for your specific circumstances by:
Getting in touch with an insurer that is also an underwriter or one that underwrites up-front
Comparing your options with an adviser
Following our guidelines and understanding how insurers treat pre-existing conditions
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 that these
- 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
Compare direct brands with a medical questionnaire upfront
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:
If you do have a pre-existing condition, you can follow these general guidelines to determine if a product is valuable to you:
- Check its definitions. Does the policy have a clear definition on what it considers a pre-existing medical condition? For instance, some policies can consider a consultation with a doctor a pre-existing medical condition.
- Check for assumptions. Policies may not ask about your specific condition and simply exclude anything not disclosed.
- Look for applications that ask about your specific condition. Specific questionnaires allow you to disclose the nature of your condition to your insurer in greater detail. This means that your insurer will have a better understanding of your condition and how it will be covered (as opposed to just denying you cover outright). An insurer will be able to tell you whether or not you are covered up-front as well.
- Be clear on how you will be covered. Make sure you understand how a specific policy will cover pre-existing medical conditions.
- What is a pre-existing condition?
- Can I get life insurance if I have a pre-existing medical condition?
- What information do insurers use to review policy applications?
- What happens if I fail to disclose a pre-existing condition?
- Debunking life insurance myths about pre-existing conditions
- How should I go about choosing a life insurance provider?
- Are there any policy clauses to be aware of if I have a pre-existing condition?
What exactly is a pre-existing condition?
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:
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.
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
- Self-inflicted injuries
- Injuries or disabilities that are not considered to be permanent
An insurance provider may request the following details while assessing your application to decide whether to provide cover:
- 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.
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.
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.
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 offers compared on this page are chosen from a range of products finder.com.au has access to track details from, and is not representative of all the products available in the market. Products are displayed in no particular order or ranking. The use of terms "Best" and "Top" are not product ratings and are subject to our disclaimer. You should consider seeking financial advice and consider your personal financial circumstances when comparing products.