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Are you or a loved one living with a pre-existing medical condition and wondering if you can still secure critical illness insurance? The answer is a resounding “yes,” and this post will guide you through the process.
We understand that health concerns can bring uncertainty, but with the right information, you can make an informed decision and get the critical illness coverage you need.
Read on to discover how a pre-existing medical condition may affect your eligibility for critical illness insurance coverage and what to do if you are declined.
- Key takeaways:
- Pre-existing conditions may affect your eligibility for critical illness insurance and the amount you have to pay.
- You'll need to disclose full details of your medical condition to the insurance company during the underwriting process.
- Working with an experienced insurance advisor will improve your chances of getting approved.
What Are Pre-existing Conditions?
Before we get into the answer to this question, let’s start by looking at what critical illness insurance is. A critical illness insurance policy provides a tax-free lump sum payment in the event of a diagnosis of a covered condition. In some cases, you have to satisfy a survival period of 30 days before you receive the critical illness benefit.
You can use the critical illness benefit to pay for additional expenses like caregiver and medical expenses. It can even afford you to travel to another country for a second opinion, allowing you to focus on recovery without worrying about your finances.
A typical critical illness insurance policy covers 25 to 26 illnesses, with life-threatening cancer, heart attack, and stroke being the most commonly claimed conditions.
How much coverage you get depends on your needs and budget, although most people buy between $50,000 to $250,000 of lump sum benefits. Once you claim for a covered condition and receive your benefit, the critical illness policy ends.
Critical illness insurance supplements disability insurance and health insurance to give you complete financial protection upon the diagnosis of life-threatening illnesses.
What is considered a pre-existing condition for critical illness insurance?
In the context of critical illness insurance, a pre-existing condition is a medical impairment that increases your likelihood of being diagnosed with a covered critical illness, like cancer or heart attack.
For example, high blood pressure, elevated LDL cholesterol, impaired glucose tolerance, and obesity are all risk factors for heart attacks. Underwriters will also want to know your lifestyle habits, like smoking and alcohol use, to determine your risk of developing heart disease.
Similarly, smoking, obesity, and alcohol use are risk factors for cancer. Since insurance companies pay out the most claims for heart attacks and cancers, underwriters will scrutinize these factors closely when you apply for critical illness insurance.
Of course, these are not the only pre-existing conditions. Many Canadians live with depression or other mental disorders, diabetes, fibromyalgia, bronchitis, and numerous other conditions. Some even have multiple impairments affecting their daily lives. How these medical conditions affect your application for critical illness insurance will depend on several factors described in the next section.
Do you have to disclose pre-existing conditions or previous diagnoses?
Absolutely. You have to disclose any pre-existing condition when you answer the medical questions. Intentionally omitting them may lead to your policy being voided. Even worse, an insurer may deny your claim, leaving you without financial protection at a time when you need it the most.
When you disclose your pre-existing medical condition on the application, the insurance company will ask follow-up questions about it. These additional questions give the underwriter more context about your impairment to assess your risk of developing a covered illness. These additional details may include:
- Date of diagnosis
- Treatment received with the completion date
- Complications
- Frequency and nature of symptoms
- Number of episodes and the amount of time since the last episode
- Restriction in daily activity
- Medical compliance
- Frequency of hospitalizations or ER visits
- Tobacco use
- Tumour stage and degree of tumour for cancers
- Recurrence or spread of the disease
- Time off work
- Family history
If the insurance company needs more information, it can ask you to undergo a medical exam, where you will have to provide blood and urine samples and blood pressure readings.
Besides a medical exam, the insurance company may also request your complete medical records from your family doctor to gain further insights into your impairments.
Can you get critical illness insurance with a pre-existing condition?
Yes, with caveats. There are several outcomes for your critical illness insurance application, as explained below.
Standard
In the best-case scenario, the underwriter does not deem your pre-existing medical condition severe enough to increase your risk of developing one of the covered conditions. Therefore, it will approve your application without modifying your critical illness insurance policy.
Rated
To account for a higher risk, insurers may modify your critical illness insurance plan with a rating. This results in higher premiums than the standard rate. Ratings range from 25% to 250%, so you could pay up to three and a half times more than the standard rate if the underwriter feels it is warranted.
Typically, the younger you were when you were diagnosed with your ailment, the higher the rating. Also, more recent diagnoses will result in higher premiums paid than ones that happened a long time ago.
The higher premium only applies to the base coverage, not optional benefits like the return of premium rider.
Exclusion
If the underwriter feels your risk is too significant to apply a rating but not enough to reject your application, it will apply an exclusion. A critical illness policy with an exclusion will exclude coverage for a specific medical impairment.
For example, if you had stage 0 or 1A skin cancer with no recurrence, you may be offered a policy with an exclusion for cancer.
Decline
A decline means the underwriter feels your chances of a claim are too great. Therefore, it will reject your application.
However, that doesn’t mean you can never buy critical illness insurance. If your situation improves, you may be able to get it once the insurance company feels your risk of becoming critically ill has lowered to an acceptable level.
Which pre-existing conditions are automatic declines for critical illness coverage?
Certain pre-existing conditions are so severe that insurance companies will not offer you a critical illness insurance policy. The following list of critical illnesses will result in an automatic decline:
- AIDS or HIV-positive
- Alcohol abuse treatment within three years
- Alzheimer’s disease
- Angina
- Aortic surgery
- Aplastic anaemia
- Bacterial meningitis
- Cancer (some exceptions may apply, like non-melanoma skin cancer)
- Chronic kidney failure
- Cirrhosis of the liver
- Coronary artery bypass surgery or angioplasty
- Cystic fibrosis
- Down syndrome
- Drug abuse within three years
- Heart attack
- Heart valve replacement
- Hepatitis C
- Huntington’s disease
- Insulin-dependent diabetes
- Major organ transplant
- Multiple sclerosis
- Muscular dystrophy
- Parkinson’s disease
- Permanent paralysis
- Polycystic kidney disease
- Stroke
Is your family history considered a pre-existing condition?
A strong positive family history of heart disease, hypertension, diabetes, or cancer, among other conditions, can significantly increase the likelihood of such diseases manifesting themselves in immediate family members.
Underwriting will take into account the nature of the disease involved and its frequency among parents and siblings. It is the age of onset that is important in assessing family history for critical illness insurance.
For example, a first-degree relative (parents or siblings) diagnosed with colorectal cancer before age 50 will lead to a rated policy for the applicant. However, if the age of onset was past 60 years old, the policy will likely be standard.
If your family has a history of serious illness, your doctor will recommend a number of preventative screening tests, including but not limited to electrocardiograms, colonoscopies, mammograms, and ultrasounds. The insurance company will want to review the test results during the application process.
How do you improve your chances of getting approved?
If you have a pre-existing medical condition, the first thing you should do is contact a licensed insurance advisor and provide all the details about your impairment.
Insurance advisors are armed with an underwriting guide from each insurance company, which specifies the likely outcome of a medical condition: standard, rated, exclusion, or declined. By providing all the information before you apply, you take the guesswork out of underwriting, avoiding unpleasant surprises.
What other options do you have if you have pre-existing conditions?
Besides fully underwritten critical illness insurance policies, you may try to get a simplified issue policy. These options may cover fewer conditions and cost more, but they are easier to qualify for.
For example, if you had cancer before, you may be able to get a policy that only covers heart disease. Another advantage is that the applications have fewer medical questions and don’t require any medical exams.
Frequently Asked Questions
Does critical illness insurance cover your pre-existing condition?
In most cases, if the underwriter deems your pre-existing medical condition severe, it will be excluded from the list of illnesses covered. That means your policy covers all other serious illnesses.
Can you get critical illness insurance after diagnosis?
The diagnosis may affect the premiums paid and whether exclusions are warranted. In any case, expect to fully disclose your diagnosis and for it to be scrutinized closely by the underwriter.
Can you get critical illness insurance if you have already had cancer?
Although the most probable outcome is a decline, it is possible to get critical illness insurance after a cancer diagnosis. In the best-case scenario, your policy will be modified with an exclusion for cancer.
Do You Have A Pre-existing Condition And Need Critical Illness Insurance?
Critical illness insurance is a crucial financial safeguard that remains accessible, even if you have pre-existing medical conditions. Your health history shouldn’t deter you from seeking the protection you and your family deserve.
Whether you’re currently managing a pre-existing condition or simply want to plan ahead, finding the right coverage is a responsible and empowering decision. Request a free quote using the form below, or use our resources to start your journey toward comprehensive critical illness coverage.
Feeling lost? Consult with an insurance expert at info@briansoinsurance.com or 604-928-1628 to explore policy options that align with your needs and budget. Secure your critical illness insurance today and enjoy the confidence that comes with knowing you’re prepared for life’s uncertainties.
Get Your Critical Illness Insurance Quote Now
While we make every effort to keep our site updated, please be aware that timely information on this page, such as quote estimates, or pertinent details about companies, may only be accurate as of its last edit day. Brian So Insurance and its representatives do not give legal or tax advice. Please consult your own legal or tax adviser. This post is a brief summary for indicative purposes only. It does not include all terms, conditions, limitations, exclusions, and other provisions of the policies described, some of which may be material to the policy selection. Please refer to the actual policy documents for complete details which can be provided upon request. In case of any discrepancy, the language in the actual policy documents will prevail. A.M. Best financial strength ratings displayed are not a warranty of a company’s financial strength and ability to meet its obligations to policyholders.
