Pre-existing medical conditions cover
Can I get life insurance with a pre-existing medical condition?
- Yes you can. However, it's crucial to disclose any relevant medical history during the application process.
Your options when it comes to pre-existing medical conditions
Contact an insurer who is an underwriter or one who uses an underwriter upfront during your application
Comparing your options with an adviser
Compare life insurance brands who may underwrite your condition upfront
How can this page help?
When it comes to life insurance, a pre-existing medical condition is usually a medical condition that occurs before the commencement of your policy where:
- A medical professional has provided you advice or treatment for the condition or
- You have experienced symptoms of a condition and are reasonably expected to seek advice or treatment
Definitions vary, brand to brand
If you have a pre-existing medical condition and are trying to purchase a new insurance policy it’s important to be aware that the language used to qualify a condition as pre-existing:
- Can vary from brand to brand.
- Can be interpreted incorrectly by the policyholder
Why do some life insurers exclude pre-existing conditions?
A brands will do this to minimise it's risk. This is because a pre-existing condition can highly increase the chances of you making a claim in the eyes of some providers.
When purchasing an insurance plan with a pre-existing medical condition or illness, you will need to disclose personal information. The required information can vary depending on the condition and brand.
1. Information about specific conditions
The conditions listed below will specific information to be disclosed:
- Asthma, sleeping disorders
- High cholesterol, blood pressure, diabetes or high blood sugar
- Skin problems such as cancers, moles or tumors
- Depression or anxiety
- Serious disorders like cancer, epilepsy, heart conditions, anemia, kidney or bladder disease or thyroid conditions.
- Female specific conditions like breast cancer
- Male specific conditions like prostate cancer
2. General medical infirmation
Other information may require you to disclose if you have been in the hospital, seen a doctor for a condition, have been prescribed medication in the 5 years before the insurance application or any of the following.
- If you made a previous claim because of an illness.
- If you have had symptoms which made you seek medical advice or a professional health practitioner and are awaiting tests or medical treatment or are taking prescriptions drugs.
- If you have had to miss work because of the condition.
- The contact information of the doctor or specialist may be required.
What types questions should I be prepared to answer in regards to my condition?
An example of the types of questions you could be asked for specific conditions include:
*Mental health conditions can include: Depression, anxiety, panic or phobia disorder, alcohol or substance abuse, schizophrenia, eating disorders, manic depressive or bipolar disorder, post-traumatic stress disorder, ADD or ADHD or the possibility for other mental health conditions.
Will I need to inform my insurer of any changes to my condition?
You will need to disclose any changes in circumstances before your insurer accepts to provide you with cover. Once they have accepted your condition and have chosen to provide you with cover, you will need to disclose any changes if you:
- Have not applied for cover yet
- Extend cover
- Vary your life insurance
- Reinstate a life insurance contract
As part of your life insurance application you may be required to undergo medical screening. Medical screenings are particularly common among older applicants and for those wanting to cover a large sum. Based on your test results, your life insurance provider looks for indicators of diseases or illnesses such as:
- Heart disease. In Australia, coronary heart disease kills more people than any other disease and in 2013 accounted for 13% of all deaths in Australia (Heart Foundation). As part of your medical screening your blood pressure is used to determine your cholesterol level as high cholesterol is an indicator of coronary artery disease. Then, depending on your age and medical history, you may need to have an electrocardiogram to check for an irregular heartbeat.
- HIV. HIV is the virus that has the potential to become AIDS. If you have contracted HIV, antibodies or antigens will have developed in response to the virus and will be present in your blood.
- Diabetes. If you have chronic diabetes you are more likely to suffer a heart attack, kidney disease, stroke and many other health conditions. Your blood and urine may be tested for unusually high glucose levels, which can be an indicator that your body is not processing sugars properly.
- Kidney disease. Kidney disease can lead to kidney failure and if you don't receive dialysis or a transplant the disease can be fatal. Your blood will be checked for high levels of blood urea nitrogen and your urine for high levels of creatinine, protein and red blood cells.
- Liver disease. Liver disease can develop into live cancer, or cause gastrointestinal bleeding. Your blood will be screened as part of a life insurance assessment, for sighs of a high bilirubin level or elevated levels of the enzymes which normally appear in liver cells.
- Cancer. Some forms of cancer can be identified through blood and urine tests. Blood cancers such as leukaemia can be identified in your blood, and bladder or kidney cancer can be identified in your urine. The levels of prostate specific antigen can also indicate prostate cancer.
When applying for life insurance, you may undergo one of the following types of medical tests:
- A check up. This type of medical test can usually be undertaken at your own GP’s office or completed by a medical nurse. This check up will record your weight and height, and may include a blood pressure and urine test.
- A check up and a blood test. In this instance you have the same tests as above, but your doctor or nurse will also take some blood to see whether you are HIV positive, or if you have illnesses such as Hepatitis. The insurer may also request a cholesterol reading.
- Personal medical attendant report. This is a detailed medical history report completed by your regular GP, which is sent off to your insurer.
During the underwriting process, your insurer will look at various life insurance risk factors, which can generally be broken down into eight risk groups:
- Your medical history. During your application for life insurance you should let your insurer know of any congenital problems, illnesses or diseases, injuries, psychological issues or any undiagnosed by ongoing symptoms.
- Your family medical history. Family history is an important indicator for ailments that are known to have familial links such as cancer, depression or congenital heart defects.
- Your lifestyle. You should inform your insurer if you're a smoker, drinker, or taking any prescription or non-prescription drugs.
- Your occupation. Your occupation, hours you work, your title, the size of the company you work for are all important factors for insurers.
- Your financial situation. Your insurer will want to make sure that the amount you're being insured for is both logical and that you will be able to keep up with the required premium repayments.
- Your participation in hazardous pursuits. Your participation in hazardous pursuits may be assessed depending on both the type of activity and your level of competency.
- Your location. Your insurer will look at your access to medical facilities and likelihood of natural disasters in the areas you work and live.
- Your present risk. Contemporary events are current risks that may pose an immediate threat such as civil unrest or natural disasters.
If your looking for additional protection that covers you in the event you suffer a serious medical condition, you may also want to consider trauma insurance. Trauma insurance provides a lump sum benefit if you suffer a condition listed on the policy. Some insurers offer cover for more than 50 conditions including: Other conditions that may be covered include:
- Alzheimers disease
- Aortic surgery
- Benign brain tumour
- Severe burns
- Chronic fatigue syndrome
- Crohn's disease
- Coronary artery angiography
- Coronary bypass surgery
- Crohn's disease
- Heart attack
- Heart conditions
- High blood pressure
- HIV accidental infection
- HIV occupational acquired
- Huntington's disease
- Kidney failure chronic
- Loss of limbs or eye
- Loss of speech
- Loss of independent existence
- Lou Gehrig's disease
- Lung disease
- Major head trauma
- Major organ transplant
- Mental illness
- Motor neurone disease
- Multiple sclerosis
- Musculoskeletal injuries
- Out of hospital cardiac arrest
- Parkinson's disease
- Peripheral neuropathy
- Sleep apnoea
- Terminal illness
If you do have a pre-existing condition in your medical or family history, don't be daunted by the medical screening life insurers conduct for diseases and health conditions. If you have a pre-existing condition when you apply for life insurance, follow these steps in your application for the greatest chance of success:
The Disability Discrimination Act of 1992 helps promote the rights of people with disabilities by regulating discrimination of theses people by life insurance companies. The act ensures that people with disabilities are able to gain coverage by making it unlawful for companies to discriminate people with disabilities during the underwriting process. The act does acknowledge that some discrimination is likely to take place as is the nature of underwriting. There are instances where risks associated an individuals disability may be far too high for the insurer to accept the risk. Different providers have different criteria for assessing people with disabilities.
If you have previously undergone genetic testing for hereditary diseases, then you could be required to disclose the results of those tests to your insurer.
nib genetic testing Health insurer nib is the first in Australia to offer genetic testing as part of their medical screening process for life insurance. nib sent direct letters to 5,000 customers offering a discounted price for a genetic test so that they could be informed about their genetic risks, and take steps to improve their health behaviours. While life insurance policies cannot be adjusted after they have been approved, if these customers wanted to change or upgrade their policies, move to a different insurer or open a superannuation fund, they would have to disclose the results of these genetic tests.
Applying for life insurance when you have a pre-existing condition can be a daunting process, so your questions are answered here:
1. Report REP 498 Life insurance claims: An industry review, 2016
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