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.

Three ways that an insurer can cover your condition

Some of the ways that life insurers will cover pre-existing conditions include:

  1. Cover with an exclusion. You will receive life insurance cover but not for your pre-existing medical condition e.g. a previous heart attack.
  2. Full cover. For some conditions, you can receive cover if your insurer agrees to cover it.
  3. Cover with a higher premium. In some cases your insurer will agree to cover your condition for an additional premium.

While you may not be able to get cover with every insurance brand in the market, there are options available to you.

Speak to an adviser about your options

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Coverage is the amount of money that you will be paid in the event of a claim. An insurance consultant can help you determine an appropriate amount. Calculator
Provides a lump sum payment if you become totally and permanently disabled and are unable to return to work.
Provides a lump sum payment if you suffer a serious medical condition. Cover can be taken out for 40-60 medical conditions depending on the policy you choose.
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What's considered a pre-existing medical condition?

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:

  1. Can vary from brand to brand.
  2. 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.

  • An illness that was diagnosed, treated or showed symptoms before the policy was purchased or insured about.
  • A health condition that made a policyholder contact a medical professional or specialist doctor.
  • Symptoms that existed before the policy was purchased that indicated an illness and led a person to seek a diagnosis or that made a doctor recommend further testing.
  • The time period of the illness, whether it’s short-term, long-term or hereditary, as examples.

What types of information about my medical history will I need to disclose?

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.

  1. If you made a previous claim because of an illness.
  2. 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.
  3. If you have had to miss work because of the condition.
  4. The contact information of the doctor or specialist may be required.

When you're applying for life insurance, an insurer will calculate the premium you'll pay based on a number of risk factors including your medical history. This process is known as the underwriting and one of the major considerations is your overall health. Insurers take into account your family medical history, personal medical history and lifestyle habits when calculating your overall health and life expectancy. Going through the underwriting process at the outset of the policy may seem a little invasive but it will give you a better understanding of the terms and conditions, and more specifically, what's covered. While there are life insurance policies available that don't require medical underwriting at the outset of a policy, there is an underwriting process if you make a claim.
Your insurer can deny a claim based on non-disclosure. In fact about 5% of all life insurance claim disputes are due to non-disclosure1.

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:

  • When were the first symptoms present and when were the most recent symptoms present.
  • Have you taken off work as a result of asthma?
  • How many asthma attacks do you have per year?
  • Are you taking medication for asthma or have you been hospitalised?
  • What sleeping conditions are you diagnosed with and when was the diagnosis made?
  • What is the severity of the sleeping disorder?
  • Have you visited a specialist doctor and received treatments or tests?
  • When were you diagnosed with raised cholesterol or high blood pressure and what were the original and most recent result of testing?
  • Have you ever or are you currently taking medication for either condition?
  • Has your treatment changed in the previous 12 months and how often do you get your blood pressure or cholesterol levels checked?
  • What type of diabetes was diagnosed?
  • When was the original diagnosis?
  • How often do you visit the doctor for monitoring and when was the most recent visit?
  • What treatments and medications are you currently taking?
  • Have you suffered any complications as a result of diabetes including insulin coma, eye problems, high blood pressure, kidney problems or numbness or tingling in your feet or legs?
  • Can you provide your most recent blood glucose and HbA1C results?
  • What type of skin problem do you currently have or have had in the past?
  • What was the location of the skin condition?
  • Was the cyst, mole or lesion removed and were any special tests or treatments were prescribed?
  • Do you have pathology results?
  • Was the skin condition benign or malignant?
  • Did you have any further treatments?
  • When did you first experience symptoms and do you currently still experience symptoms?
  • Has the cause of the problem been identified or diagnosed by a qualified health professional?
  • Are you taking medications or having treatments from a qualified councillor or therapist?
  • What is the contact information for your doctor or councillor?
  • Have you been hospitalised because of the mental health condition?
  • Has your ability to work or perform daily activities been limited because of the condition?
  • Have you attempted suicide?
  • What part of the body is affected?
  • When was your first experience and what was the potential cause of the pain?
  • Have you experienced any symptoms because of the back, neck, joint or musculoskeletal pain?
  • Have you gone through treatment and has the treatment included X-ray, CT scan or MRI?
  • Have you had to miss work as result of the pain?
  • Provide contact details for the health professionals you have visited.

*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

Life insurance and medical tests

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.

What types of tests will I need to undergo

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.

Are these types of medical test necessary?

Medical tests are not required for all types of life insurance, although submitting to a test can mean lower premiums as the insurer can better tailor your coverage. This is because the insurer wants the most accurate information possible about your health, and blood tests and medical examinations can provide this information.
  • Organise appropriate documentation such as your driver’s license or passport to verify your identity
  • Fast eight to 10 hours before your blood test
  • Drink a glass or two of water before giving a urine sample, and try and refrain from drinking alcohol for 72 hours before the test, and avoid fatty foods 24 hours before
  • If you take medications which contain paracetamol, you should avoid these for 24 to 48 hours before the test
The results of your examination are sent to your insurer, who then determines the outcome of your life insurance application. If your application is accepted then you will be sent a policy schedule to commence your coverage. If the policy is rejected based on your medical results, the insurer may offer you an alternative policy. Applicants should remember that just because one insurer may not be willing to offer them cover, does not mean that they all will. Insurance providers often have different criteria for assessing applicants, with some policies tailored specifically to different buyers.

What else is assessed during the underwriting process?

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.

What about unforeseen medical events?

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
  • Aplastic anaemia
  • Benign brain tumour
  • Blindness
  • Severe burns
  • Cancer
  • Cardiomyopathy
  • Chronic fatigue syndrome
  • Crohn's disease
  • Coma
  • Coronary artery angiography
  • Coronary bypass surgery
  • Crohn's disease
  • Deafness
  • Dementia
  • Depression
  • Diplegia
  • Encephalitis
  • Hemiplegia
  • 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
  • Osteoporosis
  • Out of hospital cardiac arrest
  • Parkinson's disease
  • Peripheral neuropathy
  • Pulmonary hypertension
  • Quadriplegia
  • Sleep apnoea
  • Stroke
  • Terminal illness

Steps to getting cover

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:

Look for an insurance broker who is experienced with impaired risk life insurance applications. If you have a pre-existing condition, you need to work with an insurance broker who has experience in securing insurance for high risk cases, and knows how to present your case to an insurer in a favourable light.
If you approach a standard insurer with an unusual application, you will usually be automatically charged extra for your coverage, or denied life insurance, because your situation is so far outside of what the insurer is equipped for and used to dealing with. However, if you can find an insurer who specialises in your particular condition, they will be able to assess your risk factors in a detailed way and give you the best value life insurance coverage.
If you approach a standard insurer with an unusual application, you will usually be automatically charged extra for your coverage, or denied life insurance, because your situation is so far outside of what the insurer is equipped for and used to dealing with. However, if you can find an insurer who specialises in your particular condition, they will be able to assess your risk factors in a detailed way and give you the best value life insurance coverage.
Before you start any applications or sourcing any quotes, make sure you have all the information about your condition available. The more information you can provide to the insurer, the better equipped they will be to assess your risk factors. This ensures full disclosure with the insurer, providing all the names of the diseases or illnesses as well as the dates, medications taken and treatments conducted. Also make sure that specific doses of medications are also listed, as well as details of any medications you are still taking. You'll need to make sure you have a list of all the medical professionals who have treated you over the last seven to 10 years and this step can take some time to organise. However, in compiling an organised and professional folder of all of this information, and making several copies for distribution, you will show you have nothing to hide, and have a greater chance of success.
As part of this file, write a summary of your health up to this point as this gives you a chance to highlight positive aspects of your lifestyle, for example, you never drink or you have never smoked, or gave up smoking 20 years ago. Also note aspects of your lifestyle such as jogging regularly, or that you go to the gym for an hour three times a week. Don't worry about including details of diseases you have recovered from as these are considered cured, and you will only need to detail information about diseases which are in remission, or those which are no longer producing symptoms even if you haven't been cured.
If there are long term effects of accidents you have been involved in, such as metal screws in your hip or a plate in your skull, include details of these.
You should be applying to at least three or four different insurers, because each will have their own underwriting process and criteria, and you are looking for aggressive and young underwriters who will take on your pre-existing condition.
It is important that you agree to any medical tests the life insurance company asks for, to provide the most detailed information for your application. Ask that your exam be scheduled for early in the day when you are awake and alert, and avoid having caffeine or sugar for 12 hours before your medical.
Diseases and health conditions assessed for a life insurance policy will differ between providers so make sure you read the fine print on the inclusions and exclusions of cover, and understand all medical testing procedures for your assessment.

What are your rights under the Disability Discrimination Act?

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.

Will I need to disclose my results of genetic testing?

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.

Some common question that we get about pre-existing medical conditions

Applying for life insurance when you have a pre-existing condition can be a daunting process, so your questions are answered here:

  • A. Yes, even if you have suffered a disease or disablement in the past, you can still apply for life insurance coverage for protection against a range of future events.
  • A. The illnesses and disabilities covered under your life insurance policy will depend on your insurer, and will be detailed in full in your product disclosure statement.
  • A. A medical exam can be as simple as checking your weight and blood pressure, or may also include a blood test, a urine test, or a cholesterol test.
  • A. It can be useful to compare insurance companies and quotes online, but if you have a specific condition to include on your application, you will receive the most accurate prices and information by calling or visiting the insurer directly.

1. Report REP 498 Life insurance claims: An industry review, 2016

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