Introduction
Having a major medical insurance is crucial not just for your health but also for your finances. A common concern, however, is what happens with pre-existing conditions. Are there options to secure your financial well-being in such cases?
Insurance companies define pre-existing conditions as illnesses that have already been diagnosed or treated before purchasing a policy. This condition might limit your options when seeking insurance, but it’s important to know that alternatives do exist.
Pre-Existing Conditions and Insurance Options
Cristóbal Ponce, president of the health committee at the Mexican Association of Insurance Brokers and Agents (Amasfac), categorizes pre-existing conditions into three groups, each with varying access to major medical insurance:
First Group: Acute Conditions with Low Risk of Recurrence
This group includes conditions like fractures or acute illnesses such as appendicitis or tonsillitis. The likelihood of an insurer granting a comprehensive major medical policy for these conditions is high, though a two-year waiting period for coverage is common.
Second Group: Non-Acute but Not Severe Conditions
Examples include renal calculi (kidney stones). Obtaining insurance in these cases can be more complex. Insurers may offer a policy with an endorsement excluding expenses related to the pre-existing condition.
Third Group: Chronic or High-Risk Conditions
This group includes conditions like cancer, diabetes, or hypertension. While most insurers are reluctant to provide policies for patients with these conditions, some do. In such cases, insurers typically charge an additional premium and exclude expenses related to pre-existing conditions.
Acceptance of patients with these types of pre-existing conditions is usually subject to a medical examination by the insurer to assess other risk factors. The time since recovery from the illness or, if still suffering, the level of control over it are also considered.
Finding the Right Insurance for You
Securing insurance with pre-existing conditions depends on each insurer’s policies and your personal medical history. Therefore, comparing all available options is essential.
Important Warning: Hiding information about pre-existing conditions can lead to severe consequences. If an insurer discovers you’ve withheld a condition, they may refuse to cover your medical expenses and terminate the contract without any refund obligation. Honesty is vital for securing your coverage and peace of mind.
Key Questions and Answers
- What are pre-existing conditions? Pre-existing conditions are illnesses that have been diagnosed or treated before purchasing a health insurance policy.
- How do pre-existing conditions affect insurance options? Pre-existing conditions can limit your choices when seeking health insurance, but alternatives do exist.
- What are the categories of pre-existing conditions? Cristóbal Ponce from Amasfac categorizes them into acute conditions with low recurrence risk, non-acute but not severe conditions, and chronic or high-risk conditions.
- What are the insurance options for each category? Acute conditions with low recurrence risk have a high chance of comprehensive coverage after a waiting period. Non-acute but not severe conditions may require an endorsement excluding related expenses. Chronic or high-risk conditions might involve additional premiums and exclusions for related expenses.
- Is it necessary to disclose pre-existing conditions? Yes, hiding information about pre-existing conditions can lead to severe consequences, including policy termination without refund.
