Understanding Chronic and Pre-Existing Conditions

When applying for private health insurance, any pre-existing medical conditions and health issues you’ve had in the past could potentially affect your coverage. Some of them could become temporary or general exclusions for your new policy. Understanding these two categories of medical conditions will help you make better choices when applying for a private medical insurance policy.

In general, most private medical insurance products exclude both pre-existing and chronic conditions. This is to help to create affordable health insurance. If these conditions were not excluded, there would be a higher number of claims making health insurance much more expensive.

At Freedom Health Insurance, we know that understanding these two main categories of medical conditions will help you make better choices when applying for a private medical insurance policy. 


What Are Considered Chronic Medical Conditions?


A chronic condition is a disease, illness or injury which has one or more of the following characteristics:

  • It is persistent and long-lasting in its effects.
  • It requires ongoing or long-term treatment to control or manage the symptoms.
  • It requires your rehabilitation or for you to be specially trained to cope with it.
  • It continues indefinitely.
  • It has no known cure.
  • It comes back or is likely to come back.
  • It needs ongoing or long-term monitoring through consultations, examinations, check-ups, and/or tests.

They are often life-long and limiting in terms of quality of life and can only be kept under control, perhaps by medication or diet or a change of lifestyle.

Some examples of common chronic conditions include asthma, diabetes, arthritis, chronic obstructive pulmonary disease, heart disease, and epilepsy.

A chronic condition is the opposite of an acute condition. An acute condition is a disease, illness or injury that comes on suddenly and without warning, unexpectedly causing pain or discomfort or other outward physical symptoms. Unlike chronic conditions, an acute condition will tend to respond quickly to a short period of treatment leading to a full recovery, restoring you to the same state of health you enjoyed before you suffered from the acute condition. Private medical insurance is designed to meet the cost of unexpected acute conditions.

Does Health Insurance Cover Chronic Conditions?

Private health insurance doesn’t cover chronic conditions. Private medical insurance is created to cover the fees for elective, short-term medical treatment that you need because you are suffering from an unexpected acute condition. Exclusions, policy terms and conditions apply.

Find out more about chronic conditions

What is a Pre-Existing Medical Condition?

A pre-existing medical condition is a disease, illness or injury for which you have received medication, advice or treatment or had any symptoms (whether the condition has been diagnosed or not) in the five years before your joining date.

Health insurance doesn’t usually cover ‘pre-existing conditions’. It only provides cover for unexpected new events that first arise after the start of cover rather than for events that have already happened or can be predicted to happen.

This means any medical condition (including symptoms and undiagnosed conditions and other related conditions) that you experienced in the five years before your cover with us started will not be covered unless we have agreed to provide cover for that medical condition.

Can I Get Health Insurance If I Have a Pre-Existing Medical Condition?

You can still get health insurance if you have pre-existing medical conditions, but it is unlikely your policy will provide cover for them. The type of underwriting of your health plan determines whether your pre-existing conditions will be covered in the future. The most common types are full medical underwriting and moratorium. 

For health insurance policies that are underwritten on a moratorium basis, any medical condition that occurred during the five years prior to the inception of your policy will be excluded for the first two years your policy is in force. Cover excluded by the moratorium may be reinstated later if the medical condition has not reoccurred for a continuous period of two years since the date it was last treated.

With full medical underwriting, you will have to answer questions about your medical history including information about pre-existing conditions. Some or all of them may not be covered by your new health insurance plan and this will be shown on your Certificate of Insurance as a written endorsement.

If you would like further information about chronic and pre-existing conditions please contact us via phone, email or using our online chat facility on our Contact Us page.

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