Insurance 101: Pre-existing conditions and health insurance

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  • Pre-existing conditions are determined as any condition which the patient has before the start of their health insurance plan.
  • Examples can include cancer, diabetes, asthma, heart conditions and high blood pressure.
  • Almost all pre-existing conditions are covered, but the extent and timing of coverage could differ.
  • Group policies will have almost immediate coverage and higher maximum limits.
  • Individual policies might have longer waiting periods for coverage commencement and lower maximum limits of coverage.
  • Make sure you find out if your health insurance policy sufficiently covers your particular pre-existing condition.

Pre-existing conditions and health insurance is a key topic for many when it comes to selecting their health insurance. Chronic illnesses or persistent diseases can plague many of us, and without access to appropriate medical care can become overwhelming. It is essential to make sure that any medical needs will be covered under your health insurance policy.

What is a pre-existing condition for health insurance?

The term itself is relatively simple to comprehend. Pre-existing conditions refer to any illness, or disease that you have had, or currently have before your health insurance begins. It also includes previous treatments you have had as well as past hospitalizations and surgeries. Examples could include:

  • Asthma
  • Cancer
  • Heart conditions
  • Diabetes
  • High blood pressure
  • Thyroid issues
  • Skin disorders

The disclosure of any pre-existing conditions you might have can, in some cases, affect the type of policy offered or the size of your premiums. This is particularly relevant for individuals with pre-existing conditions that will require substantial and regular treatment. Officially pre-existing conditions also include diseases that you don’t know you have. If your doctor finds some old heart issues that haven’t yet caused symptoms, this could be deemed a pre-existing condition.

For health insurance providers, pre-existing conditions have been the subject of much debate. Obviously, it is less costly to insure healthy people versus a chronic illness sufferer who requires regular treatments. Many insurers refuse to cover them, since they are often expensive to them, leaving many individuals without access to healthcare.

Oh no, should I be worried about my pre-existing condition?

No, you shouldn’t. Luckily the UAE offers a far more comprehensive range of health insurance policies which, to date, have not used pre-existing conditions as a chance to raise premiums. On the whole, most pre-existing conditions in the UAE will be automatically covered by your health insurance.

The Dubai government made health insurance mandatory for all residents from 2014. When they did this, various steps were taken to accommodate a wide variety of employee types. They offered lower cost insurance for lower-income workers, and they made certain pre-existing conditions had to be covered. The Dubai Health Authority makes it illegal to deny health insurance based on pre-existing conditions.

So how does it work in the UAE when it comes to pre-existing conditions?

In terms of pre-existing conditions and health insurance in the UAE, there are two slightly different approaches; large group or individual.

Group policy health insurance and pre-existing conditions

If your employer has provided your health insurance, you are more than likely on a group policy. If your company has over 100 employees, you will be on a broad group policy. When you have a group policy health insurance any, and all of your pre-existing conditions will be covered from day one. So if you sign the policy, you can go to the doctor straight away regarding any prescriptions or treatment you might need.

There are occasions in which this might change with a group policy. Some group policies will have a caveat that new hires might have to wait a short period for pre-existing conditions coverage to apply. They also might limit the amount available for this type of coverage.

If you know you have a pre-existing condition and require regular treatment, you should consult the company’s policy with your HR team.

Individual policy health insurance and pre-existing conditions

If you are self-employed or a dependant not covered by your spouse’s employer, you probably have an individual policy. An individual health insurance policy will cover any and all pre-existing conditions, but will likely have a waiting period. This might mean that the coverage will only start six months after the policy was activated. This isn’t the case for every individual policy, particularly the higher cost ones, but is worth checking if this coverage is important to you.

The essential questions about pre-existing conditions

For those of us with preliminary conditions, the worry about on-going treatment and access to healthcare can be intense. When it comes to determining which health insurance will work best for your situation, you need to make sure you know the answers to the following questions:

  • If there is any waiting period at all for your pre-existing condition coverage to start
  • If there are any maximum limit restrictions on your particular pre-existing condition coverage – for instance, if the policy specifies that it will only cover heart conditions up to a certain amount
  • If there is any limit to the types of treatment, testing, or courses of action that could be applied to your pre-existing condition. For example, if your policy only covers certain types of treatment for your particular pre-existing condition. This could also be significant in regards to trials or new medicines that might be suited to your condition.
  • If there are any restrictions on the locations of treatment or medical care.

This could be important if you have a preferred medical institution or professional who may or may not be included in the new policy’s network.

The UAE does offer some of the most generous health insurance policies when it comes to pre-existing conditions overall. However, it is essential that you determine how your particular case will be treated. Know your requirements as much as possible from the very beginning, so you know what to check in your policy. If possible, shop around and compare health insurance policies by examining their coverage of premature conditions. The more security you have with your health insurance, the more you can concentrate on just living life!

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Aqeed is on a mission to help you become better at everything related to insurance. The articles are meant to enrich your knowledge about insurance so that you make the right choices. From the decisions you make to the options you take, you are In Sure Hands.

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