EXISTING CONDITION AND HEALTH INSURANCE

PRE-EXISTING CONDITIONS IMPACT HEALTH INSURANCE

The lack of funding, services and availability of drugs in the New Zealand public health service means health insurance is increasingly becoming a necessity for timely treatment. For many people health insurance, even in their 20's, comes with pre-existing conditions attached. Even in our wee region of Kapiti, it can be a problem for many. In the future pre-existing conditions on health insurance policies are going to becoming more important. Just a 2 minute read to know what you're options are regardign exclusions on your health insurance policy.

Is there a problem?

Yes, there is. Statistically 3 in 5 people in Kapiti have no health insurance and many that do have health insurance also have exclusions or high excesses due to the premium.

What does an exclusion REALLY mean to me?

An exclusion is a condition that the policy won't cover. Every policy has exclusions in the policy wording that are openly available, however additional exclusions can then be added if there is a "pre-existing condition". That is something already there that may lead to a higher chance of a claim.

An exclusion can be quite specific as well as far reaching and will extend to directly linked future conditions, an example would be diabetes. A Diabetes exclusion will include any future complications which could include the heart, the kidneys, the skin, the list is extensive.

It's a myth that insurers go looking for an excuse to refuse a payment. Yeah, they will check the medical records to make sure there is no fraud but to decline a claim there has to be a clear medical link to the pre-existing condition.

My jobs is to unpack these exclusions for clients. Sadly some exclusions can significantly degrade a policy but I can often find another product that is suitable. A truly independent adviser knows the market and what could work for you and your family. The good news is you may be able to have some pre-existing conditions fully covered.

I don't have a pre-existing condition, there's nothing wrong!

A pre-existing condition doesn't just mean anything that you are currently suffering from, whether you've seen a doctor about it or not. It refers to any previous condition including abnormal blood tests, medications prescribed, specialist consultations, or operations. All the way back. Really, all the way back.

Not just the obvious big things either like cancer but relatively "minor" things like reflux and that sporting injury 20 years ago. A strong family history can also be taken into account. Pre-Exiting Conditions can lead to exclusions.

This isn't supposed to be all doom and gloom, there is good news. A diagnosis or injury, if it is relatively minor and not ongoing or chronic there is a possibility it won't be excluded.

Is there a policy to cover pre-existing conditions out there!

There are three main ways to get cover for pre-existing conditions. This assumes you are unlucky enough to have an exclusion on your policy.

• Have the exclusion reviewed: If the exclusion was for an injury or illness shortly before making the application it might have a time limit that could be as little as a year or two. A review will likely need evidence of a continuing clean bill of health. Your adviser will be able to help. Remember that some pre-existing conditions will never be covered.
• Join a public scheme that covers pre-existng conditions: There are policies in the market that will cover qualifying pre-existing conditions after a set time period, typically 3 years. These policies are quite different and have a variety of pros and cons. It's a good idea to get impartial advice from an adviser.
• Join an employer scheme: More businesses are giving their staff health insurance, even here in Kapiti. If the staff group is big enough qualifying pre-existing conditions will be covered immediately. The staff member can opt to take the policy when they leave the company and still maintain that benefit. This is the only way to get immediate cover for qualifying exclusions.

Bonus: Smoking, if you've quit vaping or smoking there may be more money to be saved, speak to your adviser.

You want more information?

If you are an individual, a couple or a family and want to organise health insurance then speak to one of us. Just give us a message or call. If it's there, we will find it.

If you are an employer and have 2 minutes to find out the benefits to you and your business, here's a quick read on how health insurance for staff is a wise investment. ... or youcould contact us and we'll go through options with you.

Cover Yours Ltd (FSP769531) and Marc Hamilton (FSP306046) are registered Financial Service Providers and you can search the register here. Marc Hamilton is a member of the FSCL Disputes Resolution Service. Cover Yours Ltd and Marc Hamilton’s disclosures can be found here or by emailing marc@coveryours.co.nz