Pre-existing conditions

Explanations

“Pre-existing conditions”, also known as pre-existing illnesses, refer to illnesses or symptoms that were present before the insurance policy was taken out. They are usually classified into three categories (different insurance companies may perform this categorization differently):

● Diagnosis is confirmed but no treatment has been given;
● Diagnosis is confirmed and long-term treatment has been received continuously;
● Diagnosis is confirmed, treatment has been given, but symptoms have not completely disappeared.

Pre-existing conditions generally refer to long-term, chronic, or permanent illnesses, such as diabetes and cancer. Common and easily cured illnesses like colds are usually not considered pre-existing conditions.

Pre-existing conditions can be classified as general or major pre-existing conditions, and different insurance companies may have different names and slightly different coverage. The exact terms and conditions of each insurance product should be referred to for details.

Occurrence scenarios

Critical illness insurance, medical insurance, and other similar types of insurance are usually mentioned in health declarations and exclusion clauses.

When faced with pre-existing conditions, insurance companies may choose to reject the application or offer conditional coverage, which typically involves additional premiums or the inclusion of exclusion clauses.

Examples

Client A has thyroid nodules and wants to purchase a medical insurance policy. The insurance company may offer two options:

a. Increase the premium and provide normal coverage;
b. Cover all diseases except for those related to thyroid, which will not be covered.

key points

Past medical conditions listed in the health declaration are used by the insurer to decide whether to provide insurance coverage. On the other hand, past medical conditions listed as exclusions affect whether or not claims can be paid.

In China (excluding Hong Kong, Macau, and Taiwan), the current principle followed in health declarations is the "limited disclosure" principle, which means that you should truthfully disclose the medical conditions mentioned in the questionnaire, and you don't need to disclose medical conditions not mentioned.

Failure to truthfully disclose may result in claim denial or termination of the insurance policy.

If you would like to learn more, please feel free to consult with our insurance advisors.