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Your life cover application says you must disclose all pre-existing conditions. What exactly is a pre-existing condition, how does it affect your cover and what should you do if you haven't disclosed a pre-existing condition? We asked the 1Life experts!
Pre-existing conditions defined
A pre-existing condition is a medical condition, injury or illness you currently have or have previously had, including those you have recovered from.
For example, cancer is a pre-existing condition if:
- You currently have cancer, and/or
- You previously had cancer, completed treatment and are considered cancer-free.
You could get cover with a pre-existing condition
While there are some pre-existing conditions that may affect your cover and/or premium, having a pre-existing condition does not necessarily mean you won’t qualify for cover. Many life cover applicants with pre-existing conditions do qualify for cover!
BUT:
Not disclosing a pre-existing condition that is material to the acceptance of your risk and terms offered at application stage, does mean that your claim may be declined or your cover amount adjusted, for example a lower amount than the original sum assured provided on your policy benefits. Which means your family won't enjoy the benefits of your policy and could struggle financially.
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Bottom line: Always, always disclose any pre-existing condition, and/or if you suspect you have a serious condition or illness, as well as any treatment. Let the questions posed at time of application guide your disclosure. Rather disclose too much information than too little so that our underwriters can properly assess the risk. Remember, more disclosure is better!
Have you disclosed a pre-existing condition?
If you are concerned you may not have disclosed a pre-existing condition you can contact your financial adviser or one of our skilled 1Life Insurance consultants who will help you with any queries or concerns.
How pre-existing conditions affect your cover
Depending on how serious the condition is, or was, and how well it is managed and controlled, a pre-existing condition may or may not affect your cover and/or premium in one of the following ways:
No affect
Certain conditions that are managed and well controlled may not affect your cover or premium at all.
Higher premium for cover
More serious conditions that are managed but increase your risk of developing complications and may increase your risk of dying earlier than the average life expectancy, for example diabetes, may mean you pay a higher premium. This is known as a loading in the insurance world – your premium is higher (loaded) because the risk is higher.
Exclusions
There may also be an exclusion/(s) on your cover where certain pre-existing conditions are excluded from cover. In the event of a claim related to such an excluded condition the claim will be declined.
Deferred decision
Cover may be deferred (postponed and/or not granted) pending more investigation or resolution. For example, if you are pregnant and developed diabetes during your pregnancy, the decision on cover and premium may be deferred until the baby is born.
Accidental death benefits offered
In the most serious cases life cover may be declined, and an accidental death benefit offered. This is where you are covered for death due to accidental causes such as a death due to a motor vehicle accident or death due to a gunshot in a crime, but you are not covered for death due to natural causes.
Some examples of pre-existing conditions
Pre-existing conditions require, or required, treatment and monitoring, including medication and lifestyle adaptations such as following a particular diet and exercising regularly for hypertension. Some conditions may not require regular treatment, such as daily medication, but do require periodic treatment such as a few visits to a medical practitioner each year, for example physiotherapists, psychologists, etc.
Pre-existing conditions include but are not limited to:
- Chronic conditions such as diabetes, hypertension, high cholesterol, asthma, rheumatoid arthritis and epilepsy
- Serious illnesses such as cancer, heart disease and heart attacks, strokes and tuberculosis
- Serious injuries such as a back injury that requires periodic treatment
- Serious genetic disorders such as sickle cell anaemia
- Mental health conditions such as stress, anxiety, depression and bipolar disorder
For insurance purposes, pregnancy is considered a pre-existing medical condition that you need to disclose, as well as any complications during a current or previous pregnancy such as preeclampsia or gestational diabetes.
How serious is serious? Any ongoing condition that requires monitoring and/or medication, as well as any major accident is regarded as serious. For example, you may not remember that you had a bad cold five years ago, but you are likely to remember having a heart attack that put you in hospital for five days! You are also likely to remember, or know about, serious illnesses you had as a child, but not the minor cuts, scrapes and sniffles! If in doubt disclose your medical history for your insurer to determine if the condition is material to the acceptance of the risk or not.
Tell all and enjoy the benefits
Although the vast majority of insurance claims are paid, many of those that are not paid, or not paid in full, are because there was material non-disclosure of a pre-existing condition. Disclose your pre-existing conditions when you apply for cover, when you want to increase or reinstate your cover, and your loved ones will benefit from your insurance policy when their valid claim is paid in full!
