Will My Company Health Insurance Scheme Provide Cover for Existing Medical Conditions?

We are looking to take out Health Insurance for our employees. However, we’re if an insurer will provide cover for anyone with pre-existing medical conditions. What is insurers’ stance on this?

Question asked by Seema Shah

The answer to this question depends on a number of factors. Some are specific to your company’s Health Insurance scheme and some specific to the medical condition.

Firstly, there are three types of medical underwriting for Group Health Insurance:

  • Full medical underwriting
  • Moratorium underwriting
  • Medical history disregarded.

Fully Medically Underwritten

With a fully medically underwritten scheme you disclose your past medical history when joining the scheme. The insurer then makes a judgement based on the information disclosed as to whether any exclusions are to be added to your plan.

Moratorium

A plan underwritten on a moratorium basis usually states that any medical conditions suffered in the past 5 years will not be covered for the first 2 years of the policy.

Should you not suffer any symptoms of that condition during the first two years of the plan it may be re-included within the policy at the insurer’s discretion.

Medical History Disregarded

If your company scheme is large enough (typically at least between 20-25 members), the policy can be underwritten on a medical history disregarded basis.

On this basis, there is no need to declare your medical history and your employees’ acute pre-existing medical conditions will covered upon joining the scheme.

Chronic vs Acute Conditions

Finally, note that, regardless of the policy underwriting, insurers don’t tend to cover the general everyday treatment of chronic conditions. Private medical insurance provides you with access to private healthcare for the treatment of acute conditions, which are conditions that can be treated and then pass.

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08/06/2020
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